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Should we follow an absolute LDL level or a %
reduction?
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The correlation between the
degree of cholesterol reduction and the extent of statins’
clinical benefit is controversial.
-
Post hoc analysis from WOSCOPS
and CARE showed no additional benefit to further reduction
of LDL (>24%).
-
On the other hand the relationship
was curvilinear in the 4S.
-
The ongoing SEARCH trial (simvastatin
20mg vs. 80mg) will help resolve this issue.
Which Stroke Patient
Might Benefit from a Statin?
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Hankey et al., prospectively
followed a cohort of 469 pts with TIA for an average of
4.1 years. There were 82 deaths, 51% due to coronary events.
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In the OCSP, 675 patients with first
ever stroke were followed for 6.5 years. In the first 30 days,
most deaths were related to the stroke; after that, cardiovascular
causes were most common.
-
The estimated annual absolute
risk of coronary events in pts with TIA or stroke is between
2.9 and 4.5 %.
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Typically TIA and stroke pts
have a high prevalence of vascular disease and risk factors.
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A TIA and/or stroke patients
with CHD and high or average cholesterol.
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A TIA and/or stroke patients
with vascular risk factors (HTN, DM etc) and high or average
cholesterol.
- No evidence supports the
use of statins in a TIA or stroke patient without CHD
and without vascular risk factor. Those with elevated
cholesterol should be treated.
Conclusion
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Cholesterol independent mechanisms
are likely to contribute to the cardioprotective and cerebroprotective
effects of the statins.
-
While statins are similar in
their ability to inhibit HMG CO A reductase. There are
differences at the cellular level that cast doubt about
the scientific merits of
the poorly defined class effect.
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Only natural statins have been
shown to offer primary and secondary cardiovascular disease
prevention, and primary stroke prevention.
-
TIA and stroke patients are
more likely to die of a coronary event than any other
cause, therefore every patient who qualifies should be
considered for a natural statin.
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Stroke Education
