Internal and Emergency Medicine

, Volume 7, Issue 4, pp 305–311 | Cite as

The role of statins in stroke



Although evidence from epidemiological studies examining a relationship between cholesterol level and stroke is less than definitive, there is a compelling evidence from the clinical therapy trials primarily designed to examine the coronary benefits of statins that statin therapy also causes a reduction in the risk of stroke. Even though a stroke does not have the same exact pathophysiology as a heart attack, specific trials in stroke patients confirm advantages and risks of statin therapy in this kind of population. In primary prevention, statins are effective both when low-density lipoprotein (LDL) is raised and when hs-CRP is elevated. In secondary prevention, an absolute reduction of recurrent stroke can be obtained with statins, with a number needed to treat at 5 years of 45.


Statins Ischaemic stroke Cholesterol and stroke 

Supplementary material

11739_2011_603_MOESM1_ESM.pdf (26 kb)
Supplementary material 1 (PDF 26 kb)


  1. 1.
    Expert Panel on Detection Evaluation and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program (NCEP). Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285:2486–2497Google Scholar
  2. 2.
    Castelli WP, Anderson K, Wilson PW, Levy D (1992) Lipids and risk of coronary heart disease: the Framingham study. Ann Epidemiol 2:23–28PubMedCrossRefGoogle Scholar
  3. 3.
    Prospective Studies Collaboration (1995) Cholesterol, diastolic blood pressure, and stroke: 13,000 stroke in 45,000 people in 45 prospective cohorts. Lancet 346:1647–1653Google Scholar
  4. 4.
    Tirschwell DL, Smith NL, Hecbert SR, Lemaitre RN, Longstreth WT Jr, Psaty BM (2004) Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology 63:1868–1875PubMedCrossRefGoogle Scholar
  5. 5.
    Amarenco P, Labreuche J, Lavallee P, Toubul PJ (2004) Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke 35:2902–2909PubMedCrossRefGoogle Scholar
  6. 6.
    Amarenco P, Lavallee P, Toubul PJ (2004) Stroke prevention, blood cholesterol and statins. Lancet Neurology 3:271–278PubMedCrossRefGoogle Scholar
  7. 7.
    Amarenco P, Moskowitz MA (2006) The dynamics of statin: from event prevention to neuroprotection. Stroke 37:294–296PubMedCrossRefGoogle Scholar
  8. 8.
    Lavallee P, Labreuche J, Gongola-Rivera F et al (2009) Placebo controlled trial of high dose of atorvastatin in patients with severe cerebral small vessel disease. Stroke. doi:10.1161/strokeaha.108.540088
  9. 9.
    Amarenco P, Bogousslavsky J, Callahan A et al (2006) High dose atorvastatin after stroke or transient ischemic attack. NEJM 355:549–559PubMedCrossRefGoogle Scholar
  10. 10.
    Goldstein LB, Amarenco P, Lamonte M et al (2008) Relative effects of statin therapy on stroke and cardiovascular events in men and women: secondary analysis of the SPARCL study. Stroke 39:2444–2448PubMedCrossRefGoogle Scholar
  11. 11.
    Chaturvedi S, Zivin J, Breazna A et al (2009) Effect of atorvastatin in elderly patients with a recent stroke or transient ischemic attack. Neurology 72:688–694PubMedCrossRefGoogle Scholar
  12. 12.
    Sillesen H, Amarenco P, Hennerici MG et al (2008) Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the SPARCL trial. Stroke 39:3297–3302PubMedCrossRefGoogle Scholar
  13. 13.
    Callahan A, Welch KMA, Amarenco P et al (2007) Risk of stroke and cardiovascular events in patients with type 2 diabetes or metabolic syndrome in the SPARCL trial. Diabetes 266-OR (suppl):A69 (abstr)Google Scholar
  14. 14.
    Amarenco P, Benavente O, Goldstein LB et al (2009) Results of the SPARCL trial by stroke subtypes. Stroke. doi:10.1161/strokeaha.108.534107
  15. 15.
    Ridker PM et al (2008) N Eng J Med 359(21):2195–2207Google Scholar
  16. 16.
    Ridker PM, Danielson E, Fonseca FA, for the JupiterTrial study group et al (2009) Reduction in C-reactive protein and LDL cholesterol and cardiovascular events rate after initiation of rosuvastatin: a prospective study of the Jupiter trial. Lancet 373:1175–1182PubMedCrossRefGoogle Scholar
  17. 17.
    Everett BM, Glynn RJ, MacFadyen JG, Ridker PM (2010) Rosuvastatin in the prevention of stroke among men and women with elevated levels of C-reactive protein. Justification for the use of statins prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circulation 121:143–150PubMedCrossRefGoogle Scholar
  18. 18.
    Baigent C, Keech A, Kearney PM et al (2005) Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomised trials of statins. Lancet 366:1267–1278PubMedCrossRefGoogle Scholar
  19. 19.
    LaRosa JC, He J, Vupputuri S (1999) Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 282:2340–2346PubMedCrossRefGoogle Scholar
  20. 20.
    Taylor AJ, Villines TC, Stanek EJ et al (2009) Extended-release niacin or ezetimibe and carotid intima-media thickness. N Eng J Med 361:2113–2122CrossRefGoogle Scholar
  21. 21.
    Brown BG, Zhao X-Q, Chait A et al (2001) Simvastatin and niacin, antioxidant vitamins or the combination for the prevention of coronary disease. N Eng J Med 345:1583–1592CrossRefGoogle Scholar
  22. 22.
    Brown G, Alberts JJ, Fisher LD et al (1990) Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Eng J Med 323:1289–1298CrossRefGoogle Scholar
  23. 23.
    Taylor AJ, Sullenberger LE, Lee HJ et al (2004) Arterial biology for the investigation of the treatment effects of reducing cholesterol (ARBITER 2). Circulation 110:3512–3519PubMedCrossRefGoogle Scholar
  24. 24.
    Bloomfield Rubins H, Davenport J, Babikian V et al (2001) Reduction in stroke with gemfibrozil in men with coronary heart disease and low HDL cholesterol: the veterans affairs hdl intervention trial (VA-HIT). Circulation 103:2828–2833PubMedCrossRefGoogle Scholar
  25. 25.
    Labreuche J, Toubul PJ, Amarenco P (2008) Plasma triglyceride levels and risk of stroke and carotid atherosclerosis: a systematic review of the epidemiological studies. Atherosclerosis. doi:10.1016/j.atherosclerosis.2008.08.040
  26. 26.
    Freiberg JJ, Tybjaerg-Hansen A, Jensen JS, Nordestgaard BG (2008) Nonfasting triglycerides and risk of ischemic stroke in the general population. JAMA 300:2142–2152PubMedCrossRefGoogle Scholar
  27. 27.
    Amarenco P, Goldstein LB, Callhan A et al (2008) Baseline blood pressure, low and high-density lipoproteins, and triglycerides and the risk of vascular events in the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Atherosclerosis. doi:10.1016/j.atherosclerosis.2008.09.008
  28. 28.
    Manktelov BN, Potter JF (2009) Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database Syst Rev (3):CD002091Google Scholar
  29. 29.
    Ovbiagele B, Schwamm LH et al (2010) Recent nationwide trends in discharge statin treatment of hospitalized patients with stroke. Stroke 41:1508–1513PubMedCrossRefGoogle Scholar
  30. 30.
    Squizzato A, Romualdi E, Dentali F, Ageno W (2009) Statins for acute ischemic stroke (protocol). Cochrane Database Syst Rev (1)Google Scholar
  31. 31.
    Goldstein LB, Amarenco P et al (2008) Haemorrhagic stroke in the SPARCL study. Neurology 70:2364–2370PubMedCrossRefGoogle Scholar
  32. 32.
    European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee (2008) Guidelines for management of ischaemic stroke and transient ischaemic attack. Cerebrovasc Dis 25:457–507Google Scholar
  33. 33.
    Amarenco P, Goldstein LB et al (2007) Effects of intense LDL-C reduction in patients with stroke or transient ischaemic attack: the SPARCL trial. Stroke 38:3198–3204PubMedCrossRefGoogle Scholar
  34. 34.
    Taylor F, Kirsten W et al (2011) Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev (1):CD004816Google Scholar

Copyright information

© SIMI 2011

Authors and Affiliations

  1. 1.Division of Internal MedicineASL 1 UmbriaCittà di Castello (Perugia)Italy
  2. 2.Division of Neurology, Stroke UnitASL 1 UmbriaCittà di Castello (Perugia)Italy

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