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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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References
Circulation 2002;106:3373-3421.
FULL TEXT  

Statins and stroke: evidence for cholesterol-independent effects
Di Napoli et al.
Eur Heart J 2002;23:1908-1921.
 

New Evidence for Stroke Prevention: Scientific Review
Straus et al.
JAMA 2002;288:1388-1395.
ABSTRACT | FULL TEXT  

Stroke Prevention Therapy Beyond Antithrombotics: Unifying Mechanisms in Ischemic Stroke Pathogenesis and Implications for Therapy: An Invited Review
Gorelick
Stroke 2002;33:862-875.
ABSTRACT | FULL TEXT  

Lipids and Atherosclerosis: Lessons Learned from Randomized Controlled Trials of Lipid Lowering and Other Relevant Studies
Kreisberg and Oberman
J. Clin. Endocrinol. Metab. 2002;87:423-437.
FULL TEXT  

Are high density lipoprotein (HDL) and triglyceride levels relevant in stroke prevention?
Rizos and Mikhailidis
Cardiovasc Res 2001;52:199-207.
ABSTRACT | FULL TEXT  

Treatment of the Elderly with 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitors: Focus on Drug Interactions
Davidson
J CARDIOVASC PHARMACOL THER 2001;6:219-229.
ABSTRACT  

Cholesterol lowering in the older population: time for reassessment?
Kagansky et al.
QJM 2001;94:457-463.
ABSTRACT | FULL TEXT  

Hypercholesterolemia, lipid-lowering agents, and the risk for brain infarction
Amarenco
Neurology 2001;57:S35-44.
ABSTRACT | FULL TEXT  

Reduction in Stroke With Gemfibrozil in Men With Coronary Heart Disease and Low HDL Cholesterol : The Veterans Affairs HDL Intervention Trial (VA-HIT)
Bloomfield Rubins et al.
Circulation 2001;103:2828-2833.
ABSTRACT | FULL TEXT  

Improving Lipid Evaluation and Management in Medicare Patients Hospitalized for Acute Myocardial Infarction
Malach et al.
Arch Intern Med 2001;161:839-844.
ABSTRACT | FULL TEXT  

Treatment of Older Persons With Hypercholesterolemia With and Without Cardiovascular Disease
Aronow
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:138M-145.
ABSTRACT | FULL TEXT  

Reduction of Stroke Events With Pravastatin : The Prospective Pravastatin Pooling (PPP) Project
Byington et al.
Circulation 2001;103:387-392.
ABSTRACT | FULL TEXT  

Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach
Law
Am. J. Clin. Nutr. 2000;72 :1291S-1296S.
ABSTRACT | FULL TEXT  

Long-Term Clinical and Angiographic Outcomes in Symptomatic Patients With 70% to 99% Carotid Artery Stenosis
Paciaroni et al.
Stroke 2000;31:2037-2042.
ABSTRACT | FULL TEXT  

Intake of antioxidant vitamins and risk of death from stroke in postmenopausal women
Yochum et al.
Am. J. Clin. Nutr. 2000;72:476-483.
ABSTRACT | FULL TEXT  

HMG-CoA reductase inhibitors (statins): A promising approach to stroke prevention
Hess et al.
Neurology 2000;54:790-796.
ABSTRACT | FULL TEXT  

The evolving role of statins in the management of atherosclerosis
Vaughan et al.
J Am Coll Cardiol 2000;35:1-10.
ABSTRACT | FULL TEXT  

A Novel Human Hepatic Organic Anion Transporting Polypeptide (OATP2). IDENTIFICATION OF A LIVER-SPECIFIC HUMAN ORGANIC ANION TRANSPORTING POLYPEPTIDE AND IDENTIFICATION OF RAT AND HUMAN HYDROXYMETHYLGLUTARYL-CoA REDUCTASE INHIBITOR TRANSPORTERS
Hsiang et al.
J. Biol. Chem. 1999;274:37161-37168.
ABSTRACT | FULL TEXT  

An Evidence-Based Assessment of the NCEP Adult Treatment Panel II Guidelines
Ansell et al.
JAMA 1999;282:2051-2057.
ABSTRACT | FULL TEXT  

Statins and cerebrovascular disease: plaque attack to prevent brain attack
Mohler et al.
Vasc Med 1999;4:269-272.
ABSTRACT  

Cardiovascular and renal benefits of dry bean and soybean intake
Anderson et al.
Am. J. Clin. Nutr. 1999;70:464S-474.
ABSTRACT | FULL TEXT  

Neuroprotective Properties of Statins in Cerebral Ischemia and Stroke
Vaughan and Delanty
Stroke 1999;30:1969-1973.
ABSTRACT | FULL TEXT  

Drug Treatment of Lipid Disorders
Knopp
NEJM 1999;341:498-511.
FULL TEXT  

Carotid Endarterectomy
Goldstein et al.
NEJM 1999;340:1209-1212.
FULL TEXT  

Cost-effectiveness of 3-Hydroxy-3-Methylglutaryl-Coenzyme A Reductase Inhibitors in the Secondary Prevention of Cardiovascular Disease: Forecasting the Incremental Benefits of Preventing Coronary and Cerebrovascular Events
Grover et al.
Arch Intern Med 1999;159:593-600.
ABSTRACT | FULL TEXT  

Reduction of Stroke Incidence After Myocardial Infarction With Pravastatin : The Cholesterol and Recurrent Events (CARE) Study
Plehn et al.
Circulation 1999;99:216-223.
ABSTRACT | FULL TEXT  

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Papadakis et al.
Cardiovasc Res 1998;40:265-271.
ABSTRACT | FULL TEXT  

Maximizing the Cost-effectiveness of Lipid-Lowering Therapy
Jacobson et al.
Arch Intern Med 1998;158:1977-1989.
ABSTRACT | FULL TEXT  

Time Trends in the Use of Cholesterol-Lowering Agents in Older Adults: The Cardiovascular Health Study
Lemaitre et al.
Arch Intern Med 1998;158:1761-1768.
ABSTRACT | FULL TEXT  

Coenzyme A Reductase Inhibitors and Stroke
Crouse III
ANN INTERN MED 1998;129:161-161.
FULL TEXT  

Troglitazone and Small Low-Density Lipoprotein in Type 2 Diabetes
Hirano et al.
ANN INTERN MED 1998;129:162-163.
FULL TEXT  

Fighting Heart Disease and Stroke : Recommendations of the AHA Stroke Positioning Task Force
Strauss et al.
Stroke 1998;29:1272-1273.
FULL TEXT  

Dietary Fat and Ischemic Stroke
Brunner et al.
JAMA 1998;279:1171-1173.
FULL TEXT  

Managing carotid stenosis
DTB 1998;36:9-12.
ABSTRACT | FULL TEXT  

Reductase Inhibitors: A Useless Phrase Without Specific Description
Levy
Arch Intern Med 1998;158:98-98.
FULL TEXT  

Lowering of Cholesterol Levels and the Risk of Stroke
Davey Smith et al.
Arch Intern Med 1998;158:98-99.
FULL TEXT  

Fat Chance: Diet and Ischemic Stroke
Sherwin and Price
JAMA 1997;278:2185-2186.
ABSTRACT  

Vascular Effects of Statins in Stroke
Delanty and Vaughan
Stroke 1997;28:2315-2320.
ABSTRACT | FULL TEXT  

Statins May Also Reduce Stroke Risk
Journal Watch Cardiology 1997;1997:4-4.
FULL TEXT  

Statins Reduce Stroke Incidence
JWatch Women's Health 1997;1997:1-1.
FULL TEXT  

Statin Therapy and Reduced Incidence of Stroke: Implications of Cholesterol-Lowering Therapy for Cerebrovascular Disease
Gotto
Arch Intern Med 1997;157:1283-1284.
ABSTRACT