Statins after transient ischaemic attack and ischaemic stroke.

摘要

Controversy surrounds the role of blood cholesterol as a risk factor for stroke and the management of cholesterol after stroke. Observational studies have not shown an association between blood cholesterol concentrations and risk of all stroke types, but this finding could be masking a positive association with ischaemic stroke and an inverse association with haemorrhagic stroke. That the lowering of cholesterol might increase the risk of haemorrhagic stroke is a concern.A prospective meta-analysis of 14 randomised trials of statins in 90 056 individuals (mostly asymptomatic or coronary patients) showed that a reduction in concentration of LDL cholesterol by 1 mmol/L with statins over a mean of 5 years reduced the relative risk (RR) of any major vascular event by a fifth (RR 0-79, 95% CI 0-77-0-81), including any stroke (0-83, 0-78-0-88) and ischaemic stroke (0-81, 0-74-0-89; 3-4% control, 2-8% statin), with no excess of haemorrhagic stroke (1-05, 0-78-1-41; 0-2% control, 0-2% statin).2 However, of thefew patients (n=328O) with a history of transient ischaemic attack or ischaemic stroke a mean of 4-3 years earlier, there was no significant reduction in any stroke* (0-98, 0-79-1-22) or ischaemic stroke (19% reduction, SE 12, p=0-l; 7-5% control, 6-1% statin) and there was a non-significant excess of haemorrhagic stroke (RR 1-91, 0-92-3-96; 0-7% control, 1-3% statin) in patients assigned simvastatin 40 mg daily compared with those assigned placebo. These findings were despite a reduction in LDL cholesterol by 1 mmol/L and in risk of any major vascular event by 20% (0-80, 0-71-0-92).