Can Statins Prevent the First Stroke? | Internet Stroke Center at Washington University

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Overview of Clinical Trials

Study	Agent	LDL @ baseline mg/kl	% LDL reduction	On trila LDL mg/dl	% reduction in total death	% reduction coronary events	% reduction CABG, PTCA	NTT
4S n=4444	Simvast 20-40mg	188	35	120	30 P<0.003	34 P<0.0001	37 P<0.0001	15
CARE n=4159	Pravast 40mg	139	32	95	9 P=NS	24 P<0.003	27 P<0.001	33
LIPID n=9014	Pravast 40mg	150	25	113	22 P<0.0001	24 P<0.0001	22 cabg P<0.001	28
WOSCO n=6599	Pravast 40mg	192	26	142	22 P<0.051	31 P<0.001	37 P<0.009	42
TexCAP n=6605	Lovast 20-40mg	150	25	113	0 P=NS	37 P<0.001	33 P<0.001	24

Primary Stroke Prevention and Statins

Only the CARE trial evaluated stroke as a predefined secondary endpoint in pts with MI and average level of LDL; Pravastatin produced RRR of 32% (from 7.3/1000 to 5.0/1000 person-year). 435 NNT per year to prevent one stroke. 85% of pts in this trial were on antiplatelet therapy.
Post hoc analysis from 4S showed 29% RRR with simvastatin. Stroke incidence in the placebo was 7.7/1000 person-years (similar to CARE).

Meta-Analysis

Meta-analysis of primary MI prevention (pravastatin, and lovastatin) trials found 11% (P=NS) relative risk reduction in first ever stroke.

Meta-analysis of secondary MI prevention (simvastatin, pravastatin) trials found 30% relative risk reduction in first ever stroke

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The content of these pages was written by Dr. Abdullah Nassief of Washington University School of Medicine, based on a presentation given in October of 2000.

Last Revised: October 31, 2000

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