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John Robert Crouse III, MD; Robert Patrick Byington, PhD; Helena Maria Hoen, MS; Curt Daniel Furberg, MD, PhD

Arch Intern Med. 1997;157(12):1305-1310.

Abstract
Background
Epidemiologic evidence and meta-analyses of data from early clinical trials suggest that lowering the levels of cholesterol does not reduce the events of stroke. These analyses have not included more recent clinical trials using reductase inhibitors.

Objective
To conduct a meta-analysis of the effect of reducing cholesterol levels on stroke in all reported clinical trials of primary (n=4) and secondary (n=8) prevention of coronary heart disease that used reductase inhibitor monotherapy and provided information on incident stroke.

Results
Analysis of combined data from primary and secondary prevention trials showed a highly statistically significant reduction of stroke associated with the use of reductase inhibitor monotherapy (27% reduction in stroke; 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).

Conclusions
Reductase inhibitors now in use for lowering cholesterol levels are more potent and have fewer side effects than the cholesterol-lowering agents previously available. They appear to reduce stroke, most notably in patients with prevalent coronary artery disease, which may be partly due to the effects of lowering the levels of cholesterol on the progression and plaque stability of extracranial carotid atherosclerosis or the marked reduction of incident coronary heart disease associated with treatment.

Arch Intern Med. 1997;157:1305-1310

Author Affiliations
From the Departments of Medicine (Dr Crouse) and Public Health Sciences (Drs Byington and Furberg and Ms Hoen), Bowman Gray School of Medicine, Winston-Salem, NC.

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