HMG-CoA Reductase Inhibitors Improve Acute Ischemic Stroke Outcome

Abstract

HomeStrokeVol. 36, No. 11HMG-CoA Reductase Inhibitors Improve Acute Ischemic Stroke Outcome Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBHMG-CoA Reductase Inhibitors Improve Acute Ischemic Stroke Outcome Bruce Ovbiagele, MD Bruce OvbiageleBruce Ovbiagele UCLA Stroke Center, Los Angeles, Calif Search for more papers by this author Originally published20 Oct 2005https://doi.org/10.1161/01.STR.0000185700.38737.5eStroke. 2005;36:2344Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 20, 2005: Previous Version 1 To the Editor:Dr. Moonis and colleagues are to be congratulated on an important study that provides further insight into the usefulness of statins in improving ischemic stroke outcome.1However, I disagree with the premise of the first sentence of the introductory section of their article, which reads as follows: “Prospective studies have demonstrated that HMG-CoA reductase inhibitors (statins) reduce stroke recurrence by 20% to 25%.”2,3 Indeed, there is little basis for drawing this conclusion from the studies cited to support this statement.The Scandinavian Simvastatin Survival Study demonstrated that statin treatment reduced the risk of primary stroke in a cohort of patients with coronary disease and high low-density lipoprotein cholesterol.2 Furthermore, although a post hoc analysis, not prespecified, of subjects entered into the Heart Protection Study with a history of symptomatic ischemic cerebrovascular disease revealed a significant reduction in major vascular events in favor of simvastatin, there was no beneficial treatment effect for stroke prevention by the statin agent.4 As such, currently there remains no convincing data that statins are beneficial in reducing recurrent stroke. The ongoing SPARCL study will likely shed further light on this issue.51 Moonis M, Kane K, Schwiderski U, Sandage BW, Fisher M. HMG-CoA reductase inhibitors improve acute ischemic stroke outcome. Stroke. 2005; 36: 1298–1300.LinkGoogle Scholar2 Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344: 1383–1389.MedlineGoogle Scholar3 MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360: 7–22.CrossrefMedlineGoogle Scholar4 Heart Protection Study Collaborative Group. Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20,536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004; 363: 757–767.CrossrefMedlineGoogle Scholar5 Amarenco P, Bogousslavsky J, Callahan AS, Goldstein L, Hennerici M, Sillsen H, Welch MA, Zivin J. Design and baseline characteristics of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study. Cerebrovasc Dis. 2003; 16: 389–395.CrossrefMedlineGoogle ScholarstrokeahaStrokeStrokeStroke0039-24991524-4628Lippincott Williams & WilkinsResponse:Moonis Majaz, , MD, MRCPI, DM01112005I want to thank the Dr. Bruce Ovbiagele for his thoughtful comments and his interest in our article.1 I agree that the data on risk reduction of recurrent ischemic stroke is largely based on studies in patients with ischemic heart disease.2 Interestingly, the American Stroke Association still recommends using statins in patients with ischemic stroke with or without ischemic heart disease with the aim of secondary prevention. Space limitation and the fact that the objective of this research report was to assess the effects of statins on stroke outcome and not stroke recurrence did not allow room for a more detailed discussion on statins and risk reduction of recurrent ischemic stroke. Results of the SPARCL trial should be helpful in answering this question.3 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Li A, Lv S, Yu Z, Zhang Y, Ma H, Zhao H, Piao H, Li S, Zhang N and Sun C (2013) Simvastatin attenuates hypomyelination induced by hypoxia–ischemia in neonatal rats, Neurological Research, 10.1179/016164110X12670144737774, 32:9, (945-952), Online publication date: 1-Nov-2010. November 2005Vol 36, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/01.STR.0000185700.38737.5ePMID: 16239633 Originally publishedOctober 20, 2005 PDF download Advertisement