Robert L. Trowbridge, MD
What are the benefits and harms of statins for treatment of acute cerebrovascular ischemic events?
Included studies compared statins, administered within 2 weeks of onset of acute ischemic stroke or transient ischemic attack (TIA), with placebo or no treatment, in addition to standard care. Outcomes included mortality from ischemic stroke; a composite of mortality from adverse drug effects, bleeding, and infection; and all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Stroke Group's Trials Register, Stroke Trials Directory, ClinicalTrials.gov, Current Controlled Trials (all to Nov 2010); Cochrane Central Register of Controlled Trials (Issue 4, 2010); Database of Abstracts of Reviews of Effects (Issue 4, 2010); and reference lists were searched for randomized controlled trials (RCTs) with ≥ 1 clinical outcome. Authors of published trials were contacted. 8 RCTs (n = 625) met the selection criteria. 7 trials included only patients with ischemic stroke; 1 RCT included patients with ischemic stroke and TIA. 4 RCTs assessed simvastatin, 3 assessed atorvastatin, and 1 assessed both. 1 study was judged to have low risk for bias, 1 had moderate risk, and 6 had high risk.
Meta-analysis showed that groups did not differ for all-cause mortality (Table). There were no reported deaths from ischemic stroke or from adverse drug effects, bleeding, or infections in the 6 trials (n = 444) that reported on these outcomes.
Treatment of acute cerebrovascular ischemic events with statins does not reduce all-cause mortality. Current evidence is insufficient to determine the benefits and harms of statins for treatment of acute cerebrovascular ischemic events.
*Abbreviations defined in Glossary. Weighted statin event rate, RRI, NNH, and CI calculated from odds ratio and control event rate in article using a fixed-effect model.
Trowbridge RL. Review: Insufficient evidence exists to determine the benefits and risks of statins for acute ischemic stroke or TIA. Ann Intern Med. ;155:JC6–6. doi: 10.7326/0003-4819-155-12-201112200-02006
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Published: Ann Intern Med. 2011;155(12):JC6-6.
Cardiology, Coronary Risk Factors, Dyslipidemia, Neurology, Stroke.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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