Background: Statins provide a reduction in the risk for ischaemic stroke in patients with coronary artery disease, known atherosclerotic disease, and in patients with risk factors for arterial vascular disease. There is also considerable interest in whether or not statins should be used as a secondary prophylaxis for stroke.
Materials and method: This review is based on articles included on Medline that consider the association between cholesterol and cerebrovascular disease and the use of statins in ischaemic stroke.
Results: Cholesterol is a much weaker risk factor for ischaemic stroke than for coronary heart disease. It is especially associated with thromboembolic stroke due to atherosclerosis of the larger vessels. Meta-analysis of earlier studies in patients with coronary artery disease and several more recent studies which include patients with other atherosclerotic disease and risk factors for atherosclerosis have clearly shown a relative risk reduction for ischaemic stroke of between 20 and 30%. Since these studies were of patients in age groups in which stroke rarely occurs, the relative risk reduction was moderate. Risk reduction seems similar in all age groups with atherosclerotic heart disease and for all cholesterol levels. A reduced risk for a new stroke has to date not been shown for patients with previous stroke.
Conclusion: Given the fact that stroke is caused by several mechanisms and is often not caused by atherosclerosis of larger vessels, definite advice cannot be given on secondary prevention with statins in all stroke patients. At present there are no results from studies where only ischaemic stroke patients were included and with a sufficient number of older patients.