Statins for the prevention of cerebrovascular disease: the rationale for robust intervention

Abstract

Cerebrovascular disease is one of the leading causes of morbidity and mortality worldwide, and places a huge burden on the healthcare system. The risk factors for cerebrovascular disease are, however, well established and largely modifiable. After blood pressure control, the reduction of serum cholesterol levels has the promise to provide the greatest benefit in reducing the risk of stroke. In particular, data from landmark trials have shown that lipid-lowering therapy with statins significantly reduces the risk of stroke in patients with existing coronary heart disease but no evidence of prior cerebrovascular disease. More recently, data have emerged suggesting that statin therapy is also beneficial in the secondary prevention of stroke, and ongoing trials, such as the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study, will clarify this further. Statins are likely to reduce the risk of stroke by the stabilization and/or regression of plaque, but they also exhibit pleiotropic effects (for example, anti-inflammatory and antioxidant properties), which further justify their use in the primary and secondary prevention and treatment of cerebrovascular disease.