This same trial did not find significant differences in carotid luminal diameter changes. Most of the other studies of carotid IMT changes fail to comment on changes in luminal diameter, a well-established risk factor for stroke. Certain groups of patients appear to benefit from lipid lowering with statins even if their LDL cholesterol is relatively normal. 15 Patients who took pravastatin had a significant reduction in the rate of coronary events and the need for revascularization. The rate of stroke was also reduced for those on pravastatin.
More study is needed to clarify the indications for statin use.
The Future Most of the evidence that statins can reduce the incidence of fatal and nonfatal stroke comes from trials designed to prevent first or recurrent coronary events. The average ages of the participants in many of the large completed coronary statin trials range from 55 to 62 years. This represents a much younger population than typically presents with acute ischemic stroke. It is not yet known whether statins are efficacious and cost effective in preventing recurrent strokes in the elderly. Future trials will be needed to clarify this issue, particularly in patients with borderline hyperlipidemia.