Does aggressive treatment of dyslipidemia decrease the risk of stroke?
This issue has been looked at indirectly in multiple placebo-controlled trials, as a pre-specified secondary end point. Perhaps the best place to demonstrate this is to look at the MRC/BHF study, commonly known as the Heart Protection Study.1 This is the largest trial ever done on lipid lowering. It included 20,536 people aged 40 to 80 with coronary disease, other occlusive arterial disease or diabetes with a non fasting cholesterol >3.5 mm/l. There were 6,793 subjects with a starting LDL < 3mm/l. They were randomized to 40 mg of simvastatin or a matching placebo. Follow up was for an average of 5 years. 4.3% of the simvastatin group vs. 5.7% of the placebo group suffered a stroke. (RR 75%, RRR 25%, ARR 1.4% NNT 71). This small but consistent effect is seen in multiple trials. There were no excess hemorrhagic strokes in the treatment arm. Does smoking increase the risk of stroke? What evidence do we have? Clearly we do not have the best Level 1 evidence here as no randomized controlled
