Impact of Statins on Risk of Stroke: A Meta-Analysis

Nickole N Henyan, PharmD; Daniel M Riche, PharmD BCPS; Honey E East, MD; Pamela N Gann, PharmD


The Annals of Pharmacotherapy. 2007;41(12):1937-1945. 

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Despite the large size of the meta-analysis (n = 100,660), we recognize several limitations. First, several studies reported data on all CVEs, but fewer than half reported the incidence of hemorrhagic or ischemic stroke. Data for hemorrhagic and ischemic stroke from all included studies would have provided additional power and potentially added to a more conclusive interpretation of the results. However, there were more than 37,000 patients in the ischemic analysis and more than 57,000 in the hemorrhagic analysis, suggesting adequate power. Secondly, the definition of stroke, fatal stroke, and CVE was not uniform across all studies, potentially introducing investigator bias, especially in trials with an open-label design. Finally, publication bias is a concern with any meta-analysis. Publication bias results from the greater ease of finding studies that yielded significant or positive results, potentially leading to overrepresentation of benefit in systematic reviews. In light of the Egger weighted regression p values, the potential for publication bias appears minimal.

Lipophilic statins cross the blood-brain barrier, while hydrophilic statins may not.[56,57] Whether degree of penetration of the blood-brain barrier alters the neuroprotective effects of statins remains unclear. Future trials (eg, FASTER and J-STARS; identifiers NCT00109382 and NCT00221104, respectively) should help further define the role of statins in overall stroke prevention.


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