BMJ  2006;333:148 (15 July), doi:10.1136/bmj.333.7559.148-a

Letter

Cholesterol and risk of stroke

Study lumps apples and oranges

The first 150 words of the full text of this article appear below.

EDITOR—The statement by Ebrahim et al, that "preventive strategies that include lowering blood cholesterol should not be tempered because of concerns about a possible increased risk of haemorrhagic stroke" is too general and does not acknowledge that their study population did not include patients with symptomatic vascular disease, the population most often aggressively treated with statins, with resultant low cholesterol concentrations.¹

These patients frequently have cerebral vessels diseased with atherosclerosis, and evidence of silent cerebral infarcts.² Indeed, the only randomised trial to evaluate an intensive statin treatment strategy in patients primarily with ischaemic stroke noted a higher incidence of haemorrhagic stroke among those who received the high dose statin.³ In another study there was a trend towards increased haemorrhagic stroke with statin use among those who had had a cerebrovascular event.⁴

Another limitation of their study is the lack of information on low density liproprotein cholesterol concentrations, the . . . [Full text of this article]

Stroke Center and Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095, USA ovibes@mednet.ucla.edu

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