This review considers the evidence showing that
statins can prevent first or recurrent
stroke or improve its outcome in subjects at moderate or high risk for
cardiovascular disease (CVD). Data are reviewed according to trial design (observational or prospective) and baseline CVD risk. Two (ASCOT, CARDS) out of five primary CVD prevention
statin trials showed a considerable reduction in
stroke rates. In two (MIRACL and PROVE IT) out of five
acute coronary syndrome trials, the prevention of first
stroke was significant. Most
secondary prevention trials (4S, CARE,
LIPID, HPS, GREACE and
TNT) showed a beneficial effect of
statins in
stroke prevention. Finally, SPARCL, the only secondary
stroke prevention trial in subjects without overt
coronary heart disease (CHD), showed a significant reduction in total and ischaemic (fatal and nonfatal)
stroke rate, although a small but significant increase in nonfatal haemorrhagic
stroke was noted. There was also a significant reduction in CHD-related events. The possible mechanisms responsible for
statin-associated
stroke prevention are discussed. The evidence suggests the need to consider early and long-term
statin treatment (with substantial
low-density lipoprotein cholesterol reduction) in all patients at high risk of any type of major vascular event, without discriminating CHD from
stroke. Thus,
statins may be beneficial to both the heart and the brain.