Statins in stroke prevention

Cholesterol lowering with statins has been proven to reduce vascular events in primary and secondary prevention of coronary artery disease (CAD). Epidemiologic studies found no or little association between blood cholesterol levels and stroke. However, randomized trials in patients with CAD have shown that statins decrease stroke incidence. These statin trials indicate 21% relative risk reductions for stroke. In subgroup analysis of the Heart Protection Study, simvastatin had no effect on stroke recurrence, in patients with a previous stroke. Recently, Stroke Prevention by Aggressive Reduction in Cholesterol Levels study showed that treatment with high dose atorvastatin reduced risk of stroke in patients with recent stroke and transient ischemic attack and no known CAD. In this review, we will discuss the effects of statins on stroke and the potential mechanisms of action.