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Statins 'reduced risk of stroke by 30%'

Statins and fibrates could reduce the risk of a stroke in healthy older adults by 30%, according to a new study.

The French research study, published in the BMJ this week, concluded that such a reduction ‘could have an important effect on public health in other populations’.

The researchers tracked 7,484 men and women (average age 74 years) with no known history of vascular events, such as heart attacks and strokes.

They wanted to determine the association between the use of lipid-lowering drugs (statins or fibrates) in healthy older people and the long-term risk of coronary heart disease and stroke.

As part of the observational study, face-to-face examinations took place every two years to ascertain the occurrence of any adverse cardiac event or hospital admission, and to record which lipid-lowering drug each participant had been using.

Trained nurses and psychologists also performed interviews and took various physical and cognitive measurements. Factors such as education, occupation, income and lifestyle were collected as part of each follow-up visit.

After an average follow-up time of nine years, the researchers found that the use of statins or fibrates was associated with a 34% reduced risk of stroke compared with non-users. The type of lipid-lowering drug used – statin or fibrate – did not significantly alter the result, with risk reductions of 32% and 34% respectively, compared with non-users. The risk of coronary heart disease was not significantly lowered with lipid-lowering medication.

The researchers said: ‘The risk of coronary heart disease was not lower in lipid-lowering drug users. In contrast, we observed a one-third decrease in the risk of stroke in lipid-lowering drug users compared with non-users.’

Christophe Tzourio, Professor of Epidemiology at University of Bordeaux and Inserm, said the French population has a low risk of stroke so, in populations more exposed to the risk of stroke, a one-third reduction in stroke risk ‘could have an important effect on public health’.

Graeme Hankey, professor of neurology at the University of Western Australia, said the study’s results were ‘sufficiently compelling to justify further research, testing the hypothesis that lipid lowering may be effective in the primary prevention of stroke in older people’.

He said that the decision to start statins for the primary prevention of vascular disease in people over 75 ‘continues to be based on sound clinical judgment’, after considering each patient’s predicted vascular risk with and without statins, their predicted risk of adverse effects, and the patient’s own priorities and preferences for treatment.

This comes after NICE’s decision to halve the risk threshold for the use of statins in the primary prevention of cardiovascular disease to 10%, despite calls from the BMA and other clinical experts to drop the proposal because of concerns it will lead to overtreatment.

Readers' comments (3)

  • Vinci Ho

    Surprise that coronary artery disease was not prevented in these 7484 patients? Quite in contrary to the result from previous studies ?
    (1)Considering each patient's predicted risk with and without statin--- the calculator almost always showed high CVD risk over 75 e.g. 20% . According to this philosophy , all over 75 should be on statin.
    (2)Their predicted risk of adverse effects --- since nobody can firmly say what is the incidence of some well publicised side effect e.g. CK normal myalgia (which can matter a lot in these over 75 years old patients), this remains as an uncertainy.
    (3)So we always go back to the art of medicine , not the science, that patient has to have a say on this primary prevention but how often we hear , ' I leave it to you as you are the expert , what do you think,doc?'
    The dilemma should be debated more sensibly and transparently with a consciousness of reality..,,,,

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  • 1 "No association between total incidence of vascular events and lipid lowering drug use"
    2 "All cause mortality lower; hazard ratio 0.87"
    Given the extensive use of statistics it is surprising they could not translate this into the benefit for a whole patient
    Perhaps because it sounds so awful when you do
    How much testing, prescribing, signing, chasing,consulting are we compelled to do and for what?There is no association.

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  • Samuel Lewis

    This observational study is worthless.

    There are many many blinded randomised controlled trials definitely showing consistent 30% reductions in stroke and heart attacks, regardless of age, risk cholesterol level, etc.

    But it is true that statistically significant reduction in mortality has not been shown in the low ten-year cvd category 10 to 15%.

    BBC NEWS reported this week that statins lower cancer mortality 'by up to 50%'. Again a worthless and biaseds observational study, that actually reported a mean reduction of 20%, subject to selection bias.

    The RCT evidence clearly showed no difference in cancer incidence or mortality (CTT Metanalysis).

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