Simvastatin reduces stroke and major vascular events in people at high-risk

Abstract

QuestionDoes simvastatin reduce the risk of stroke and other major vascular events in people at high risk or with cerebrovascular disease?Study designRandomised controlled trial.Main resultsAt 1 year, there was no significant difference in stroke between groups, however at 5 years, simvastatin significantly reduced stroke by 25% compared with placebo (see Results table). There was no significant difference in presumed haemorrhagic stroke between groups (simvastatin vs. placebo: 51 [0.5%] vs. 53 [0.5%]; RR 0.95, 95% CI 0.65 to 1.40, p=0.80). Simvastatin significantly reduced presumed ischaemic stroke compared with placebo; this accounted for the overall difference in stroke rate between groups (simvastatin vs. placebo: 290 [3%] vs. 409 [4%]; RR 0.70, 95% CI 0.60 to 0.81, p<0.0001). At 5 years, simvastatin significantly reduced major vascular events, major coronary events, and revascularisation compared with placebo. In people with pre-existing cerebrovascular disease, simvastatin did not reduce stroke compared with placebo although major vascular event rates were reduced (406 [25%] vs. 488 [30%]; p=0.001).Authors’ conclusionsPeople at high risk of stroke are likely to benefit from simvastatin. Simvastatin had no significant effect on stroke in people with pre-existing cerebrovascular disease, but did reduce major vascular events.