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(9411)757-67.
The Heart Protection Study Collaborative Group recently performed an analysis of the effects of cholesterol lowering with simvastatin on strokes and other major vascular events. This study involved 3,280 adults with cerebrovascular disease, as well as 17,256 adults with diabetes or occlusive arterial disease. They were randomly allocated 40 mg simvastatin or placebo on a daily basis.
Over the 5-year treatment period, 4.3% of the simvastatin group, versus 5.7% of the placebo group, had stroke. This was a significant reduction of 28% (95% CI 19-37) in ischemic strokes, with no difference in strokes due to hemorrhage. The reduction in strokes was more significant by the second year. Even when the pretreatment low density lipoprotein cholesterol was below 116 mg/dL, additional lowering of the low density lipoprotein cholesterol to an average of 77 mg/dL was associated with a reduced first stroke risk of 30%, compared to the placebo level of 102 mg/dL.
These results are significant because they demonstrate the benefits of statins to reduce stroke risk. Statin therapy should be considered for all patients at high risk of stroke regardless of their initial cholesterol concentration or the presence of coronary disease.