The incidence of stroke was obtained from study investigators. Conclusion Lowering LDL cholesterol levels by using statin monotherapy reduces stroke in patients with coronary heart disease. Commentary Stroke is often devastating to patients and is a major public health burden. No randomized controlled trial has shown that lipid lowering reduces stroke as a primary end point, and no clear statistical association of stroke incidence with serum cholesterol levels has been shown. Nevertheless, the meta-analysis by Crouse and colleagues reveals a reduction in stroke incidence, although the result may be limited to patients with coronary heart disease.
Intervention is again justifiable without invoking stroke reduction.
For patients with modestly elevated cholesterol levels and no other risks, the benefits for prevention of coronary heart disease and possibly stroke are more modest, although a patient-centered decision to use these drugs could be driven more by the fear of stroke than by fear of myocardial infarction. Craig Redfern, DO Providence Ambulatory Care and Education Center Portland, Oregon, USA Reference 1. Arch Intern Med. All rights reserved.