Abstract
BackgroundStroke is a frequently encountered clinical event that has a detrimental impact on the quality of life. Evidence has increasingly shown that statins can substantially reduce the risk of coronary heart disease. However, it remains to be determined whether statins are definitively effective in preventing stroke.MethodsWe systematically searched the PubMed, Embase, and Central databases for studies that compared the effects of statins and placebo in patients at high risk for stroke. The outcome measures were overall incidence of stroke, incidence of fatal stroke, and incidence of hemorrhagic stroke.ResultsEighteen randomized controlled trials satisfied all the inclusion criteria for the meta-analysis. The analysis revealed that statins reduced the overall incidence of stroke than placebo (odds ratio [OR]: 0.80; 95% confidence interval [CI]: 0.74–0.87; P<0.00001). In particular, statins showed efficacy in reducing the incidence of fatal stroke (OR: 0.90; 95% CI: 0.67–1.21; P = 0.47) and hemorrhagic stroke (OR: 0.87; 95% CI: 0.60–1.25; P = 0.45). On the contrary, they were found to increase the overall incidence of stroke (OR: 1.12; 95% CI: 0.89–1.41; P = 0.32) and fatal stroke (OR: 1.37; 95% CI: 0.93–2.03; P = 0.11) in renal transplant recipients and patients undergoing regular hemodialysis.ConclusionThe results of this analysis suggest that statins may be beneficial in reducing the overall incidence of stroke and they may decrease the risk of fatal stroke and hemorrhagic stroke. However, statins should be used with caution in patients with a history of renal transplantation, regular hemodialysis, transient ischemic attack, or stroke. Further analyses should focus on multicentre, double-blind, placebo-controlled randomized trials with data stratification according to the nature of primary diseases and dose–effect relationship, to clarify the benefits of statins in protection against stroke.
Highlights
Stroke leads to disturbances in the blood supply to the brain, which can lead to the rapid deterioration of brain function
Inclusion criteria Studies were included in the meta-analysis if they fulfilled the following criteria: (1) enrolled subjects had high risk of stroke due to prevalent conditions (CHD, diabetes mellitus, hypertension, myocardial ischemia, and hypercholesterolemia) and were of mean age$50 y; (2) the studies were randomized clinical trials (RCTs) conducted on humans; (3) the dosage of statin therapy was specified; (4) the details regarding the type of stroke, including fatal stroke and hemorrhagic stroke, were reported; and (5) the incidence of stroke in the study population was specified or could be calculated
Subgroup analysis In order to evaluate the efficacy of statins in patients with end-stage renal disease, a subgroup analysis was performed on trials that included only renal transplant recipients or patients undergoing regular hemodialysis
Summary
Stroke leads to disturbances in the blood supply to the brain, which can lead to the rapid deterioration of brain function. Several largescale clinical trials have been conducted to evaluate the efficiency of statins in the primary and secondary prevention of atherosclerosis and stroke [7,8,9]. While some of these trials have shown the beneficial effect of statins in stroke prevention, others have not. Evidence has increasingly shown that statins can substantially reduce the risk of coronary heart disease. It remains to be determined whether statins are definitively effective in preventing stroke
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