HMG-CoA reductase inhibitors (statins) - A promising approach to stroke prevention

Statins represent a promising class of agents to prevent stroke. In randomi zed trials of middle-aged patients with coronary artery disease, statins re duce the incidence of stroke. The reduction in stroke may not be solely rel ated to cholesterol or low-density lipoprotein reduction but may involve no nsterol mechanisms effects on endothelial cells, macrophages, platelets, an d smooth muscle cells. Statins also reduce the size of cerebral infarction in a murine stroke model, suggesting a neuroprotective effect. The best cur rent evidence for stroke prevention is with pravastatin and simvastatin. Pr avastatin reduces the risk of stroke in patients with coronary artery disea se and average cholesterol levels; simvastatin reduces the risk of the comb ined endpoint of stroke and transient ischemic attack in hypercholesterolem ic patients with coronary artery disease. Future studies of statins are nee ded in stroke populations, particularly the elderly.