Advances in Emerging Therapies 2009

Abstract

Stroke has multiple etiologies and presents in many forms. Therefore, it will continue to pose challenges in prevention, diagnosis, and treatment. 2009 has brought modest advances in terms of new acute stroke therapies but has provided encouraging preliminary reports of possible developments to come. The main progress of 2009 has been in the area of primary and secondary prevention, providing exciting new therapies that are likely to alter our practice significantly in the future. Prevention is better than cure. Statins have a role alongside antithrombotic and antihypertensive agents for secondary prevention of stroke.1 The JUPITER investigators recently demonstrated the efficacy of a statin for primary prevention.2 JUPITER was a randomized, double-blind, placebo-controlled trial of high-dose rosuvastatin (20 mg per day). The study population consisted of 17 802 apparently healthy men (>50 years of age) and women (>60 years of age) who, at screening, had low levels of low-density lipoprotein cholesterol (<3.4 mmol/L) and increased levels of high-sensitivity C-reactive protein (<2.0 mg/L). Nearly 90 000 patients had to be screened to attain this enrollment. The trial was stopped early after median follow-up of only 1.9 years of the planned 4 because of a striking reduction in the primary end point of first major cardiovascular event: 0.77 versus 1.36 events per 100 person years of follow-up, respectively (hazard ratio for rosuvastatin, 0.56; 95% CI, 0.46 to 0.69; P <0.00001). Of these major cardiovascular events, there were 33 strokes in the rosuvastatin group (n=8901) and 64 strokes in the placebo group (n=8901). This 48% reduction in stroke risk was found to be driven by a reduction in ischemic cerebrovascular events. There were similar numbers of hemorrhagic stroke in both groups. Subgroup analysis suggested that the patients who gained most benefit from rosuvastatin therapy were those with increased traditional risk factors, such …