There is evidence that statin therapy in patients with a history of ischaemic stroke or TIA significantly reduces subsequent major coronary events but only marginally reduces the risk of stroke recurrence .
There is no clear evidence of beneficial effect from statins in those with previous haemorrhagic stroke and it is unclear whether statins should be started immediately post stroke or later .
BACKGROUND Studies have shown that interventions which reduce total and low-density lipoprotein cholesterol levels also reduce coronary heart disease ( CHD ) and stroke events in those with a history of CHD .
However , it is uncertain whether treatment to alter cholesterol levels can prevent recurrence of either stroke or subsequent cardiovascular events and whether differences in outcomes exist between classes of lipid-lowering therapy .
This is an up date of a Cochrane review first published in 2002 .
OBJECTIVES To investigate the effect of altering serum lipids pharmacologically for preventing subsequent cardiovascular disease and stroke recurrence in patients with a history of stroke .
High-dose atorvastatin after stroke or transient ischemic attack.
BACKGROUND Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease ; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack ( TIA ) remains to be established . METHODS We r and omly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry , had low-density lipoprotein ( LDL ) cholesterol levels of 100 to 190 mg per deciliter ( 2.6 to 4.9 mmol per liter ) , and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo .  The primary end point was a first nonfatal or fatal stroke . RESULTS The mean LDL cholesterol level during the trial was 73 mg per deciliter ( 1.9 mmol per liter ) among patients receiving atorvastatin and 129 mg per deciliter ( 3.3 mmol per liter ) among patients receiving placebo . During a median follow-up of 4.9 years , 265 patients ( 11.2 percent ) receiving atorvastatin and 311 patients ( 13.1 percent ) receiving placebo had a fatal or nonfatal stroke ( 5-year absolute reduction in risk , 2.2 percent ; adjusted hazard ratio , 0.84 ; 95 percent confidence interval , 0.71 to 0.99 ; P=0.03 ; unadjusted P=0.05 ) . The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes , whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes . The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent ( hazard ratio , 0.80 ; 95 percent confidence interval , 0.69 to 0.92 ; P=0.002 ) . The overall mortality rate was similar , with 216 deaths in the atorvastatin group and 211 deaths in the placebo group ( P=0.98 ) , as were the rates of serious adverse events . Elevated liver enzyme values were more common in patients taking atorvastatin . CONCLUSIONS In patients with recent stroke or TIA and without known coronary heart disease , 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events , despite a small increase in the incidence of hemorrhagic stroke . ( Clinical Trials.gov number , NCT00147602 [ Clinical Trials.gov ] . )
There is evidence that statin therapy in patients with a history of ischaemic stroke or TIA significantly reduces subsequent major coronary events but only marginally reduces the risk of stroke recurrence .
There is no clear evidence of beneficial effect from statins in those with previous haemorrhagic stroke and it is unclear whether statins should be started immediately post stroke or later .
BACKGROUND Studies have shown that interventions which reduce total and low-density lipoprotein cholesterol levels also reduce coronary heart disease ( CHD ) and stroke events in those with a history of CHD .
However , it is uncertain whether treatment to alter cholesterol levels can prevent recurrence of either stroke or subsequent cardiovascular events and whether differences in outcomes exist between classes of lipid-lowering therapy .
This is an up date of a Cochrane review first published in 2002 .
OBJECTIVES To investigate the effect of altering serum lipids pharmacologically for preventing subsequent cardiovascular disease and stroke recurrence in patients with a history of stroke .