Does Lipid-Lowering Therapy Decrease the Risk of Stroke?
Until recently, treatment of elevated serum (LDL)-cholesterol levels was thought to be of minor benefit in reducing the risk of stroke. Indeed, in an overview of randomized trials that included more than 36,000 individuals, no significant reduction in the incidence of fatal and nonfatal strokes was observed (odds ratio = 1.1 and 1.0, respectively), despite a 6-23% decrease in serum total cholesterol levels obtained through dietary modifications or administration of fibratcs or resins [Atkins et al., 1993; Heberl ct al., 1995]. These conclusions have been challenged since the introduction of HMG-CoA reductase inhibitors (statins). Over the last 5 years, 13 different trials [Blauw et al., 1997; Grouse et al., 1997; Hebert et al., 1997], including three major intervention studies have been reported where statins had been administered in primary (WOSCOPS) [Shepherd el al., 1995] or secondary prevention (4S [Scandinavian Simvastatin Survival Study Group, 1994] and CARE [Sacks et al., 1996])
