REDUCTASE INHIBITOR MONOTHERAPY AND STROKE PREVENTION

Background: Epidemiologic evidence and meta-analyses of data from earl y clinical trials suggest that lowering the levels of cholesterol does not reduce the events of stroke. These analyses have not included mor e recent clinical trials using reductase inhibitors. Objective: To con duct a meta-analysis of the effect of reducing cholesterol levels on s troke in all reported clinical trials of primary (n=4) and secondary ( n=8) prevention of coronary heart disease that used reductase inhibito r monotherapy and provided information on incident stroke. Results: An alysis of combined data from primary and secondary prevention trials s howed a highly statistically significant reduction of stroke associate d with the use of reductase inhibitor monotherapy (27% reduction in st roke; P=.001). Analysis of secondary prevention trials alone disclosed a similar statistically significant effect (32% reduction in stroke; P=.001). A smaller nonsignificant reduction in stroke was noted in the primary prevention trials (15% reduction in stroke; P=.48). Conclusio ns: Reductase inhibitors now in use for lowering cholesterol levels ar e more potent and have fewer side effects than the cholesterol-lowerin g agents previously available. They appear to reduce stroke, most nota bly in patients with prevalent coronary artery disease, which may be p artly due to the effects of lowering the levels of cholesterol on the progression and plaque stability of extracranial care tid atherosclero sis or the marked reduction of incident coronary heart disease associa ted with treatment.