Pravastatin therapy and the risk of stroke.

Background: Several epidemiologic studies have concluded that there is no r elation between total cholesterol levels and the risk of stroke. In some st udies that classified strokes according to cause, there was an association between increasing cholesterol levels and the risk of ischemic stroke and a possible association between low cholesterol levels and the risk of hemorr hagic stroke. Recent reviews of trials of 3-hydroxy-3-methylglutaryl-coenzy me A reductase inhibitors have suggested that these agents may reduce the r isk of stroke. Methods: In a double-blind trial (the Long-Term Intervention with Pravastat in in Ischaemic Disease study), we compared the effects of pravastatin on m ortality due to coronary heart disease (the primary end point) with the eff ects of placebo among 9014 patients with a history of myocardial infarction or unstable angina and a total cholesterol level of 155 to 271 mg per deci liter (4.0 to 7.0 mmol per liter). Our goal in the present study was to ass ess effects on stroke from any cause and nonhemorrhagic stroke, which were secondary end points. Results: There were 419 strokes among 373 patients over a follow-up period of six years. A total of 309 strokes were classified as ischemic, 31 as hem orrhagic, and 79 as of unknown type. Among the patients given placebo, the risk of stroke was 4.5 percent, as compared with 3.7 percent among those gi ven pravastatin (relative reduction in risk, 19 percent; 95 percent confide nce interval, 0 to 34 percent; P=0.05). Nonhemorrhagic stroke occurred in 4 .4 percent of the patients given placebo, as compared with 3.4 percent of t hose given pravastatin (reduction in risk, 23 percent; 95 percent confidenc e interval, 5 to 38 percent; P=0.02). Pravastatin had no effect on hemorrha gic stroke (incidence, 0.2 percent in the placebo group vs. 0.4 percent in the pravastatin group; P=0.28). Conclusions: Pravastatin has a moderate effect in reducing the risk of stro ke from any cause and the risk of nonhemorrhagic stroke in patients with pr evious myocardial infarction or unstable angina. (N Engl J Med 2000;343:317 -26.) (C) 2000, Massachusetts Medical Society.