Pravastatin therapy and the risk of stroke

White, Harvey D. , Simes, R. John, Anderson, Neil E. , Hankey, Graeme J. , Watson, John D. G. , Hunt, David, Colquhoun, David M. , Glasziou, Paul , MacMahon, Stephen, Kirby, Adrienne C. , West, Malcolm J. and Tonkin, Andrew M. (2000) Pravastatin therapy and the risk of stroke. New England Journal of Medicine, 343 5: 317-326. doi:10.1056/NEJM200008033430502

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Author White, Harvey D.
Simes, R. John
Anderson, Neil E.
Hankey, Graeme J.
Watson, John D. G.
Hunt, David
Colquhoun, David M.
Glasziou, Paul
MacMahon, Stephen
Kirby, Adrienne C.
West, Malcolm J.
Tonkin, Andrew M.
Title Pravastatin therapy and the risk of stroke
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
1533-4406
Publication date 2000-08-03
Sub-type Article (original research)
DOI 10.1056/NEJM200008033430502
Open Access Status File (Publisher version)
Volume 343
Issue 5
Start page 317
End page 326
Total pages 10
Place of publication Waltham, MA, United States
Publisher Massachusetts Medical Society
Collection year 2000
Language eng
Formatted abstract
Background: Several epidemiologic studies have concluded that there is no relation between total cholesterol levels and the risk of stroke. In some studies 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 hemorrhagic stroke. Recent reviews of trials of 3-hydroxy-3-methylglutaryl–coenzyme A reductase inhibitors have suggested that these agents may reduce the risk of stroke.

Methods: In a double-blind trial (the Long-Term Intervention with Pravastatin in Ischaemic Disease study), we compared the effects of pravastatin on mortality due to coronary heart disease (the primary end point) with the effects 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 deciliter (4.0 to 7.0 mmol per liter). Our goal in the present study was to assess 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 hemorrhagic, 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 given pravastatin (relative reduction in risk, 19 percent; 95 percent confidence 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 those given pravastatin (reduction in risk, 23 percent; 95 percent confidence interval, 5 to 38 percent; P= 0.02). Pravastatin had no effect on hemorrhagic 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 stroke from any cause and the risk of nonhemorrhagic stroke in patients with previous myocardial infarction or unstable angina.
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Tue, 10 Jun 2008, 21:01:31 EST