Statin therapy to prevent stroke in the elderly
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Corresponding author Richard A. Bernstein, MD, PhD Feinberg School of Medicine of Northwestern University, Abbott Hall 11th Floor, 710 North Lake Shore Drive, Chicago, IL 60611, USA. E-mail: [email protected] Current Cardiovascular Risk Reports 2007, 1:324–329 Current Medicine Group LLC ISSN 1932-9520 Copyright © 2007 by Current Medicine Group LLC
The incidence of stroke increases with advanced age, and improved strategies for preventing both first and second stroke in the elderly are needed. Recent trials prove that low-density lipoprotein reduction by statins in high-risk patients, including the elderly, reduces the risk of ischemic stroke. Patients with any history of cerebrovascular disease who are treated with statins have a reduced risk of coronary ischemic events and of all major vascular ischemic events, independent of patient age. Patients with recent transient ischemic attack or ischemic stroke show significantly reduced risks of both recurrent stroke and coronary events when they are treated with high-dose statin therapy. The vast majority of patients with ischemic cerebrovascular disease, most of whom are elderly, should be placed on statin drugs. However, the majority of stroke patients are not currently treated to recommended levels, and the elderly are particularly undertreated. No valid reasons exist for avoiding statins in elderly patients at risk for stroke.
Introduction The risk of stroke increases with increasing age. Most elderly people fear a stroke more than other diseases. Stroke is the third leading cause of death and the leading cause of disability in the elderly [1]. Medical therapies that can prevent first or second stroke in the elderly are needed, especially given that the elderly constitute the fastest growing demographic in the United States. The epidemiologic link between serum low-density lipoprotein (LDL) cholesterol levels and coronary heart disease (CHD) is clear [2–4]. LDL-lowering therapy is highly beneficial after myocardial infarction [5]. The link between elevated total or LDL cholesterol and all stroke has been controversial [6,7], although a weak association with ischemic stroke has been found [7]. Early trials of
cholesterol-lowering therapies failed to show a clear effect on ischemic stroke, but the potency of the therapies tested was low, and these studies were likely underpowered [8]. Later trials with more potent agents, including HMG-coA reductase inhibitors (statins), focused on patients with established CHD, who have higher short-term risks of coronary events than stroke [9]. Combined analyses show that statin therapy lowers the risk of ischemic stroke in patients with CHD [10,11]. Analysis of the effects of cholesterol reduction on stroke occurrence is complicated by the failure of some trials to systematically determine stroke subtype (hemorrhagic vs ischemic) [7,12]. Recent studies and meta-analyses, however, have clarified the effects of LDL-reduction therapy with statins on ischemic stroke. These results have major treatment implications for patie
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