Graeme J. Hankey, MD, FRACP, FRCP
In adults, do statins prevent stroke and reduce mortality?
Selected studies compared a statin (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin) with placebo or no treatment and reported on clinically important cardiovascular outcomes. Studies that reported only surrogate outcomes (e.g., low- and high-density lipoprotein levels) were excluded. Outcomes were all-cause mortality and all-stroke incidence. Secondary outcomes included cardiovascular deaths, nonhemorrhagic and hemorrhagic cerebrovascular events, and fatal strokes.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine Database, CINAHL, TOXNET, Development and Reproductive Toxicology, Hazardous Substances Databank, PsycINFO, and Web of Science (all from inception to December 2006) and references of published systematic reviews and health technology assessments were searched for randomized controlled trials (RCTs). 42 RCTs (n = 121 285) met the selection criteria: 8 used atorvastatin (n = 23 724), 6 used simvastatin (n = 26 146), 5 used fluvastatin (n = 5191), 18 used pravastatin (n = 57 573), 4 used lovastatin (n = 8102), and 1 used any statin (n = 481).
Meta-analysis showed that statins were more effective than placebo or no treatment for reducing all-cause mortality and all strokes (Table). Statins prevented cardiovascular deaths (17 trials, n = 57 599, RR 0.81, 95% CI 0.74 to 0.90) and nonhemorrhagic cerebrovascular events (11 trials, n = 58 604; RR 0.81, CI 0.69 to 0.94). Groups did not differ for hemorrhagic strokes (11 trials, n = 54 334; RR 0.94, CI 0.68 to 1.30,) and fatal strokes (21 trials, n = 82 278; RR 0.99, CI 0.80 to 1.21). Preplanned meta-regression showed that every unit increase in low-density lipoprotein cholesterol level increased mortality risk by 0.3% (RR 1.003, CI 1.0005 to 1.006).
Statins prevent all strokes and reduce all-cause mortality.
Statins vs placebo or no treatment for the prevention of stroke and mortality*
*Abbreviations defined in Glossary; weighted event rates, NNT, and CI calculated from relative risk and control event rate in article.
Hankey GJ. Review: Statins prevent stroke and reduce mortality. Ann Intern Med. ;149:JC1–7. doi: 10.7326/0003-4819-149-2-200807150-02007
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Published: Ann Intern Med. 2008;149(2):JC1-7.
Cardiology, Coronary Risk Factors, Dyslipidemia, Neurology, Stroke.
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