Hypolipemic Drugs in the Prevention of Ischemic Strokes
Authors:
V. Soška
Authors‘ workplace:
Oddělení klinické biochemie a II. interní klinika LF MU a FN u sv. Anny v Brně
Published in:
Cesk Slov Neurol N 2010; 73/106(1): 20-25
Category:
Review Article
Overview
Hypolipidemic drugs, and statins in particular, are very important in the prevention of both primary and secondary coronary events. These drugs also play an important role in the prevention of ischemic stroke, despite the fact that their part in relative risk reduction for ischemic stroke is less than that of treatment with antiplatelet or antihypertensive drugs. When considering the results of interventional studies, the statins gemfibrozil and nicotinic acid may be used for primary prevention of ischemic stroke. These drugs can decrease the risk of ischemic stroke in patients with dyslipidemia and coronary heart disease, but certain other statins (e.g. atorvastatin, rosuvastatin) can also decrease the risk of stroke in high-risk people without cardiovascular disease provided their LDL-cholesterol is above target level. Atorvastatin (80 mg a day) is the only hypolipidemic drug that has provided evidence for secondary prevention of ischemic stroke. When choosing a hypolipidemic drug for the prevention of stroke based on clinical studies, one should always consider which study population is involved and which drug has been used for the prevention of ischemic stroke.
Key words:
cholesterol – ischemic stroke – statins – fibrates – niacin – ezetimibe – resins
Sources
1. Neaton JD, Blackburn H, Jacobs D, Kuller L, Lee DJ, Sherwin R et al. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med 1992; 152(7): 1490–1500.
2. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C et al; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol lowering treatment: prospective meta‑anylysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005; 366(9433): 1267–1278.
3. Law MR, Wald NJ, Thopmson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ 1994; 308(6925): 367–372.
4. Amarenco P. Lipid lowering and recurrent stroke: another stroke paradox. Eur Heart J 2005; 26(18): 1818–1819.
5. Prospective Studies Collaboration. Cholesterol, diastolic blood pressure and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet 1995; 346(8991–8992): 1647–1653.
6. Lewington S, Whitlock G, Clarke R, Sherliker P, Emberson J, Halsey J et al. Blood cholesterol and vascular mortality by age, sex, and blood pressure: meta‑analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Lancet 2007; 370(9602): 1829–1839.
7. Lindenstrøm, Boysen G, Nyboe J. Influence of total cholesterol, high density lipoprotein cholesterol and triglycerides on risk of cerebrovascular disease: the Copenhagen city study. BMJ 1994; 309(6946): 11–15.
8. Iso H, Jacobs DR Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six‑year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med 1989; 320(14): 904–910.
9. Tell GS, Crouse JR, Furberg SD. Relationship between blood lipids, lipoproteins, and cerebrovascular atherosclerosis. A review. Stroke 1988; 19(4): 423–430.
10. Vaverková H, Soška V, Rosolová H, Češka R, Cífková R, Freiberger T et al. Doporučení pro diagnostiku a léčbu dyslipidemií v dospělosti, vypracované výborem České společnosti pro aterosklerózu. Vnitř Lék 2007; 53(2): 181–197.
11. The stroke prevention by aggresive reduction in cholesterol levels (SPARCL) investigators. High‑dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549–559.
12. Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB et al. Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high‑density lipoprotein cholesterol. N Engl J Med 1999; 341(6): 410–418.
13. Školoudík D, Bar M, Václavík D, Škoda O, Korsa J,Hradílek P et al. Riziko vzniku vaskulární příhody při léčbě fluvastatinem a fenofibrátem. Cesk Slov Neurol N 2007; 70/103(2): 163–167.
14. Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR et al. Effects of long‑term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 2005; 366(9500): 1849–1861.
15. Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, et al. Fifteen year mortality in coronary drug project patients: long term benefit with niacin. J Am Coll Cardiol 1986; 8(6): 1245–1255.
16. The Lipid Research Clinics Coronary Primary Prevention Trial results. I. Reduction in incidence of coronary heart disease. JAMA 1984; 251(3): 351–364.
17. Amarenco P, Labreuche J, Lavallée P, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta‑analysis. Stroke 2004; 35(12): 2902–2909.
18. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333(20): 1301–1307.
19. Downs JR, Clearfild M, Weis S, Whitney E, Shapiro DR, Beere PA et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998; 297(20): 1615–1622.
20. The Kyushu Lipid Intervention Study. Pravastatin use and risk of coronary events and cerebral infarction in Japanese men with moderate hypercholesterolemia. J Atheroscler Thromb 2000; 7(2): 110–121.
21. Colhoun HM, Thomason MJ, Mackness MI, Maton SM, Betteridge DJ, Durrington PN et al. Design of the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with type 2 diabetes. Diabet Med 2002; 19(3): 201–211.
22. Ridker P, Danielson E, Fonseca FAH, Genest J, Gotto AM, Kastelein JJ et al. Rosuvastatin to prevent vascular events in men and women with elevated C‑reactive protein. N Eng J Med 2008; 359(21): 2195–2207.
23. Di Napoli M, Schwaninger M, Cappelli R, Ceccarelli E, Gianfilippo GD, Donati C et al. Evaluation of C‑reactive protein measurment for assesing the risk and prognosis in ischemic stroke: a statement for health care professionals from the CRP pooling project members. Stroke 2005; 36(6): 1316–1329.
24. Vlachová I, Herzig R, Vaverková H, Novotký D, Krčová V, Bártková A et al. Prediktivní hodnota ultrasenzitivního C‑reaktivního proteinu u cévní mozkové příhody a jeho vztah k ateroskleróze karotid. Cesk Slov Neurol N 2007; 70/103(1): 49–55.
25. Václavík D, Školoudík D, Škoda O, Prax P, Axmanová K, Vlachová I. Asociace vybraných rizikových faktorů s tíží aterosklerotického postižení v karotické bifurkaci. Cesk Slov Neurol N 2008; 71/104(3): 285–292.
26. Sever P, Dahlöf B, Poulter N, Wedel H, Beevers G, Caulfield M et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower‑than‑average cholesterol concentrations, in the Anglo‑Scandinavian Cardiac Outcomes Trial‑Lipid Lowering Arm (ASCOT‑LLA): a multicentre randomised controlled trial. Lancet. 2003; 361(9364): 1149–1158.
27. Knopp RH, d’Emden M, Smilde JG, Pocock SJ. Efficacy and safety of atorvastatin in the prevention of cardiovascular end points in subjects with type 2 diabetes: the Atorvastatin Study for Prevention of Coronary Heart Disease Endpoints in non‑insulin‑dependent diabetes mellitus (ASPEN). Diabetes Care 2006; 29(7): 1478–1485.
28. ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high‑risk hypertensive patients randomized to angiotensin‑converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid‑Lowering Treatment to Prevent Heart Attack Trial (ALLHAT‑LLT). JAMA 2002; 288(23): 2981–2997.
29. Shepherd J, Blauw GJ, Murphy MB, Bollen E, Buckley BM, Cobbe SM et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002; 360(9364): 1623–1630.
30. Scandinavian Simvastatin Survival Study (4S). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet 1994; 334(8934): 1383–1389.
31. The Long‑term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339(19): 1349–1357.
32. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996; 335(14): 1001–1009.
33. Collins R, Armitage J, Parish S, Sleigh P, Peto R. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo‑controlled trial. Lancet 2003; 361(9374): 2005–2016.
34. Athyros VG, Papageorgiou AA, Mercouris BR, Athyrou VV, Symeonidis AN, Basayannis EO et al. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. Curr Med Res Opin 2002; 18(4): 220–228.
35. Waters DD, Schwartz GG, Olsson AG, Zeiher A, Oliver MF, Ganz P et al. Effects of atorvastatin on stroke in patients with unstable angina or non‑Q-wave myocardial infarction. Circulation 2002; 106(13): 1690–1695.
36. Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004; 350(15): 1495–1504.
37. de Lemos JA, Blazing MA, Wiviott SD, Lewis EF, Fox KA, White HD et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292(11): 1307–1316.
38. Pedersen TR, Faergeman O, Kastelein JJ, Olsson AG, Tikkanen MJ, Holme I et al. High‑dose atorvastatin vs usual‑dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study: a randomized controlled trial. JAMA 2005; 294(19): 2437–2445.
39. LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352(14): 1425–1435.
40. Mazighi M, Lavallée PC, Labreuche J, Amarenco P.Statin therapy and stroke prevention: what was known, what is new and what is next? Curr Opin Lipidol 2007; 18(6): 622–625.
41. Rossebø AB, Pedersen TR, Boman K, Brudi P, Chambers JB, Egstrup K et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 2008; 359(13): 1343–1356.
42. Kalita Z, Keller O, Bar M, Mikulík R, Škoda O, Neumann J. Doporučený postup sekundární prevence recidivy po akutní cévní mozkové příhodě: mozkovém infarktu/tranzitorní ischemické atace a hemoragické cévní mozkové příhodě. Cesk Slov Neurol N 2008; 71/104 (3): 372–378.
43. Amarenco P, Lavallee P, Touboul PJ. Stroke prevention, blood cholesterol and statins. Lancet Neurol 2004; 3(5): 271–278.
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Paediatric neurology Neurosurgery NeurologyArticle was published in
Czech and Slovak Neurology and Neurosurgery
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