STROKE, STATINS, AND CHOLESTEROL - A METAANALYSIS OF RANDOMIZED, PLACEBO-CONTROLLED, DOUBLE-BLIND TRIALS WITH HMG-COA REDUCTASE INHIBITORS

Background and Purpose To estimate the effect of 3-hydroxy-3-methylglu taryl-coenzyme A (HMG-CoA) reductase inhibitors (''statins'') on strok e risk, we combined the data of the randomized, placebo-controlled, do uble-blind trials with HMG-CoA reductase inhibitors published so far. Methods The studies were identified using the Medline CD+ and Current Contents databases from January 1980 through May 1996, inclusive. All studies were evaluated on the use of a placebo control, monotherapy, a nd double blindness. When the type of stroke or the occurrence of clin ical events or adverse effects were incompletely or notreported, the i nvestigators were contacted personally. For each trial, the number of strokes in the treatment arm was compared with the number of strokes e xpected on all observations under the assumption that drug treatment h ad no effect. Results A total of 462 strokes among 20 438 participants in 13 trials could be analyzed. A total of 181 strokes were observed in patients randomized to treatment with an HMG-CoA reductase inhibito r and 261 strokes in patients randomized to placebo. A lower than expe cted number of strokes was observed in the treatment groups of all but one trial (P=.001). Treatment with an HMG-CoA reductase inhibitor led to an overall risk reduction of 31% (odds ratio, 0.69; 95% confidence interval, 0.57 to 0.83). Conclusions The combined data suggest that t reatment with HMG-CoA reductase inhibitors prevents stroke in middle-a ged persons. Because stroke is especially common in older age, these d ata reinforce the need for clinical trials to evaluate the effect of H MG-CoA reductase inhibitors in preventing stroke in the elderly.