Although statin therapy has been as...

Although statin therapy has been associated with an approximately 25 percent reduction in coronary marked occurrences the impact on strokes is les clear. A possible positive weight on ischemic strokes in younger patients may be counterbalanced on a negative association with hemorrhagic visitation especially in patients with high family pressure. The Heart Protection inquiry a large, prospective international trial, studied the purports on stroke of lowering offspring cholesterol with statin drugs.

The meditation recruited more than 20,000 patients 40 to 80 years of age who had cholesterol plains of at least 135 mg by dL (3.50 mmol per L) and a history of diabetes or cerebrovascular, coronary, or occlusive arterial disease; men 65 and older with treated hypertension also were eligible. Exclusions from the application of mind included patients with significant coronary or cerebrovascular affairs within the previous six months; hepatic, renal, or muscular problems; contraindications to statin therapy; and comorbid conditions that could increase mortality or cause compliance problems

After screening, including laboratory testing and advice about risk factors for vascular disease, participants took placebos for a four-week "run-in" period. This stair was followed by four to six weeks of treatment with simvastatin at a dosage of 40 mg daily. Compliant patients who had no contraindications were then randomly assigned to continue taking simvastin or to take a placebo for five years.

Patients were assessed in studious mood clinics at four, eight, and 12 month then each six months. The data amassed included regular laboratory monitoring of participants and information about incident afflictions cardio-vascular episodes, and other serious medical conditions. Data were garner uped from the records of primary care physicians, death certificates, and national registers of cancer, pat and other conditions in the participating countries. misfortunes had to be confirmed as the cause of either neurologic deficit lasting more than 24 hours or death. Imaging or autopsy evidence was used to classify hits into ischemic, hemorrhagic, and other categories. Rankin scores were used to classify the severity of each stroke

A total of 3280 patients with cerebrovascular disease and 17256 other high-risk patients were included. Of those with cerebrovascular disease at minute to the study, 63 percent had a history of ischemic thump 46 percent had transient ischemic attacks, and 10 percent had undergone carotid surgery Aspirin was used according to 77 percent of participants with a history of cerebrovascular disease. from one extremity to the other of the study, 85 percent of patients in the treatment collection took simvastatin as prescribed. About 17 percent of the placebo assemblage also received nonstudy statin drugs

The overall reduction in misfortune was 25 percent. This reduction was principally the be the effect of a 30 percent reduction in ischemic blows The incidence of stroke in patients with a history of cerebrovascular disease was not improved by dint of statin therapy, but stroke incidence cruel by 34 percent in other high-risk patients. Rates of hemorrhagic reverses were comparable in the statin-treated and placebo clumps The reduction in strokes became apparent during the inferior year of the study. Significant reductions were noted in the incidence of transient ischemic attacks and carotid surgeries in all patients excluding those with preexisting conditions. Benefits also were noted in cardiovascular disease. Overall, a 24 percent reduction was noted in time to first coronary occurrence in patients randomized to statin therapy. In patients with a history of cerebrovascular circumstances there was a highly significant 20 percent reduction in major vascular facts in patients taking statins.

The authors calculate that simvastatin therapy reduc the rate of attacks in high-risk patients by about individual fourth, and that with well adapted compliance, it could reduce the rate according to up to one third. They estimate that statin therapy precludeed 16 first or subsequent hits per 1,000 patients during the five-year follow-up period. The benefits of knock prevention were equivalent in the major categories of patients, as it was as those with coronary disease, diabetes, or hypertension, as well as patients older than 70 years of age, and those with initially elevated lipid levels

ANNE D WALLING, MD meanings of cholesterol-lowering with simvastatin forward stroke and other major vascular incidents in 20 536 people with cerebrovascular disease or other high-risk conditions. Heart Protection studious mood Collaborative Group. Lancet March 6 2004;363:757-67

COPYRIGHT 2004 American Academy of Family Physicians

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