Reduction In Cholesterol Levels Trial Research Articles

Statin Therapy Should Not be Discontinued in Patients With Intracerebral Hemorrhage

The case under question reports spontaneous cerebellar hemorrhage in a 72-year-old man with a history of hypertension, lacunar stroke, and mild cognitive impairment. In the natural history of small vessel disease, the likely pathological situation causing this case, ischemic and hemorrhagic events, represents different expressions of the same underlying microangiopathy. These 2 phenotypes may require different therapeutic approaches. The concern in this patient, on statin therapy for ischemic stroke prevention, is that he now has an intracerebral hemorrhage (ICH). So, what should we do with statins when brain ischemia and hemorrhage are both on board? Several years ago, neurologists feared this situation, and withdrawal was the main approach taken. At that time, we were probably influenced by the side effects observed in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial (high-dose statins increasing the risk of hemorrhagic stroke) and concerned about the association between low-density lipoprotein level and hemorrhagic stroke, claimed by many authors. However, changes are coming, and new evidence supports the notion that maintaining our …

High-Dose Statin Therapy for Secondary Prevention of Stroke

It has been shown that HMG-CoA (3-hydroxy-3-methylglutaryl coenzyme A) reductase inhibitors (statins) lower the incidence of a first stroke in patients with coronary heart disease, diabetes, or risk factors for cardiovascular disease. However, it is unknown whether statin therapy could reduce the incidence of a second stroke in patients without evidence of heart disease. This article reviews the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial, a prospective, randomized, multicentered, double-blind, placebo-controlled, international trial designed to examine the effect of high-dose atorvastatin on secondary stroke prevention. Trial participants (4,731) had experienced a stroke or transient ischemic attack within 1 to 6 months before randomization into the study. Over the 5-year follow-up period, incidence of second stroke or transient ischemic attack was significantly reduced in the atorvastatin treatment group compared with the placebo group. In addition, high-dose atorvastatin therapy significantly decreased major coronary artery and other negative cardiovascular events. The reduction in incidence of secondary stroke was specific to ischemic stroke as opposed to hemorrhagic stroke. Results of the trial are clinically significant and support extension of the latest secondary stroke prevention guidelines to include statin therapy for those patients without coronary heart disease.