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• W1968014927 abstract "We support Clive Rosendorffs conclusion in his April 4 commentary1Rosendorff C Statins for the prevention of stroke.Lancet. 1998; 351: 1002-1003Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar that statins may be effective in the prevention of stroke, but we disagree with his underlying assumptions and clinical reasoning. In sharp contrast with his opening statement, there is conclusive evidence that cholesterol is not a risk factor for stroke.2Prospective Studies CollaborationCholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts.Lancet. 1995; 346: 1647-1652Summary PubMed Google Scholar The fact that non-statin cholesterol-lowering drugs lack beneficial effects on risk of stroke corroborate this finding. In this respect, the finding that statins reduce the risk of stroke are amazing. A possible explanation is that statins have a cholesterol-independent effect on cerebrovascular disease. The effects of statins on coronary heart disease support this hypothesis. The risk reduction of coronary events by statins is largely independent of the cholesterol concentration at baseline.3Scandinavian Simvastatin Survival Study Group.Baseline cholesterol and treatment effect in the Scandinavian Simvastatin Survival Study (4S).Lancet. 1995; 345: 1274-1275Crossref PubMed Scopus (310) Google Scholar The clinical message of these observations is that cholesterol concentrations should not be used to consider treatment for the prevention of stroke.Should all individuals at high risk of coronary and cerebrovascular disease be offered intensive lipid-lowering treatment with statins to prevent stroke? The real answer is that we do not know yet. The reported favourable effects of statins on reducing the risk of stroke are obtained from middle- aged patients with coronary heart disease. This group of patients is only a small subset of the population susceptible to stroke, and among this subset a large proportion of the strokes are caused by ischaemia, mostly due to atherosclerotic disease. The effect of statin treatment is therefore likely to be beneficial. However, since the pathogenesis of stroke is thought to be heterogeneous, there is no evidence that all types of stroke and thus various groups of patients will benefit from treatment. In our meta-analysis of the available data4Blauw GJ Lagaay AM Smelt AHM Westendorp RGJ Stroke, statins and cholesterol. A meta-analysis of randomised, placebo-controlled, double-blind trials with HMG-CofA reductase inhibitors.Stroke. 1997; 28: 946-950Crossref PubMed Scopus (323) Google Scholar we showed that statins do not reduce the number of fatal strokes.Thus, with the data available it is difficult to extrapolate the beneficial effects of statins in middle-aged individuals to the elderly population among whom strokes occur most frequently. Extrapolation becomes even more hazardous when realising that among the elderly cholesterol is not a risk factor for coronary heart disease.5Weverling-Rijnsburger AWE Blauw GJ Lagaay A Knook DL Meinders AE Westendorp RGJ Total cholesterol and risk of mortality in the oldest old.Lancet. 1997; 350: 1119-1123Summary Full Text Full Text PDF PubMed Scopus (413) Google Scholar We support Clive Rosendorffs conclusion in his April 4 commentary1Rosendorff C Statins for the prevention of stroke.Lancet. 1998; 351: 1002-1003Summary Full Text Full Text PDF PubMed Scopus (13) Google Scholar that statins may be effective in the prevention of stroke, but we disagree with his underlying assumptions and clinical reasoning. In sharp contrast with his opening statement, there is conclusive evidence that cholesterol is not a risk factor for stroke.2Prospective Studies CollaborationCholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts.Lancet. 1995; 346: 1647-1652Summary PubMed Google Scholar The fact that non-statin cholesterol-lowering drugs lack beneficial effects on risk of stroke corroborate this finding. In this respect, the finding that statins reduce the risk of stroke are amazing. A possible explanation is that statins have a cholesterol-independent effect on cerebrovascular disease. The effects of statins on coronary heart disease support this hypothesis. The risk reduction of coronary events by statins is largely independent of the cholesterol concentration at baseline.3Scandinavian Simvastatin Survival Study Group.Baseline cholesterol and treatment effect in the Scandinavian Simvastatin Survival Study (4S).Lancet. 1995; 345: 1274-1275Crossref PubMed Scopus (310) Google Scholar The clinical message of these observations is that cholesterol concentrations should not be used to consider treatment for the prevention of stroke. Should all individuals at high risk of coronary and cerebrovascular disease be offered intensive lipid-lowering treatment with statins to prevent stroke? The real answer is that we do not know yet. The reported favourable effects of statins on reducing the risk of stroke are obtained from middle- aged patients with coronary heart disease. This group of patients is only a small subset of the population susceptible to stroke, and among this subset a large proportion of the strokes are caused by ischaemia, mostly due to atherosclerotic disease. The effect of statin treatment is therefore likely to be beneficial. However, since the pathogenesis of stroke is thought to be heterogeneous, there is no evidence that all types of stroke and thus various groups of patients will benefit from treatment. In our meta-analysis of the available data4Blauw GJ Lagaay AM Smelt AHM Westendorp RGJ Stroke, statins and cholesterol. A meta-analysis of randomised, placebo-controlled, double-blind trials with HMG-CofA reductase inhibitors.Stroke. 1997; 28: 946-950Crossref PubMed Scopus (323) Google Scholar we showed that statins do not reduce the number of fatal strokes. Thus, with the data available it is difficult to extrapolate the beneficial effects of statins in middle-aged individuals to the elderly population among whom strokes occur most frequently. Extrapolation becomes even more hazardous when realising that among the elderly cholesterol is not a risk factor for coronary heart disease.5Weverling-Rijnsburger AWE Blauw GJ Lagaay A Knook DL Meinders AE Westendorp RGJ Total cholesterol and risk of mortality in the oldest old.Lancet. 1997; 350: 1119-1123Summary Full Text Full Text PDF PubMed Scopus (413) Google Scholar" @default.
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• W1968014927 title "Statins for prevention of stroke" @default.
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