Pravastatin Therapy Decreases the Risk of Stroke

August 03, 2000

New York (MedscapeWire) Aug 3 — Individuals with existing coronary heart disease had a moderately decreased relative risk of stroke if they were taking pravastatin, a drug used to treat high cholesterol, compared with a group of patients who received a placebo drug, according to a study in the August 3 issue of the New England Journal of Medicine. All of the 9014 individuals studied had either suffered a heart attack or had been diagnosed with unstable angina, but not all of the patients had high cholesterol.

"Although the decrease in the relative risk of stroke may seem modest, the significance of this study is that it showed a reduced risk of stroke in individuals already at high risk because of their coronary heart disease history," says Ralph Sacco, MD, a spokesperson for the American Heart Association.

"People who have had heart disease are at increased risk of stroke because of atherosclerosis. This disease process that underlies heart attacks can also cause a stroke," says Sacco, associate chair of neurology at Columbia University College of Physicians and Surgeons.

During the 6-year study, the patients who took the statin drug had a 19% relative risk reduction of stroke. The patients given the placebo had a 4.5% risk compared with 3.7 for those who took the statin. The study followed patients to determine if pravastatin could reduce the risk of death from coronary artery disease. The study included data on ischemic stroke (caused by a blood clot or other obstruction in an artery) and hemorrhagic stroke (caused by a burst artery). Both types of stroke interrupt or block blood flow to the brain.

"It should also be noted that the cholesterol levels of the participants, which ranged between 155-271 mg/dL, were not especially high. This indicates that pravastatin may lower the relative risk of stroke by some other mechanism which has not been identified yet, since all of the individuals did not have elevated cholesterol," says Sacco.

"There has been some concern for patients at risk of stroke that lowering cholesterol too much might increase the risk of hemorrhagic stroke. This study did not find such an association," he says.

"Although it is too soon to recommend cholesterol-lowering drugs for individuals at risk for stroke, this significantly contributes to the evolving knowledge about cholesterol reducing agents and the risk of both ischemic and hemorrhagic stroke," says Sacco.

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