Fillers POEM

Lipid lowering prevents stroke in patients with or without CHD

BMJ 2005; 330 doi: (Published 10 March 2005) Cite this as: BMJ 2005;330:0-g

Question In patients with or without heart disease, does lowering the lipid concentration decrease the risk of stroke?

Synopsis The authors of this meta-analysis set out to determine whether lipid lowering of any type—we already know that statins work—decreases the likelihood of stroke in patients with or without coronary heart disease (CHD). They started by identifying all 65 randomised controlled trials comparing any intervention with placebo or usual diet, which included a total of 200 607 patients. They conducted the appropriate search of five databases, with articles in all languages, and searched reference lists. Two investigators independently assessed the studies and their quality and evaluated the possible influence of study quality on the results. As has been shown, treatment with a statin decreased the risk of fatal and non-fatal strokes by approximately 25% in patients with or without CHD (primary and secondary prevention). For patients at low risk (0.2% likelihood per year in these studies), this benefit translates into one less stroke for every 2778 patients treated for one year (95% confidence interval 2083 to 5000). For those at high risk (0.9% per year), the benefit was one less stroke for every 617 patients treated for one year (463 to 1111). The benefit was not quite as pronounced in the higher quality studies that used concealed allocation when enrolling patients. Treatment with other cholesterol lowering approaches, including diet, did not affect stroke risk.

Bottom line Statins produce a statistically significant 25% average reduction in the risk of experiencing either a fatal or non-fatal stroke. Other approaches to lipid lowering do not. However, before we start putting statins in the drinking water we need to realise that this reduction translates into one less stroke in every 2778 patients at low risk (that is, without heart disease) and one less stroke for every 617 patients with pre-existing heart disease.

Level of evidence 1a (see Systematic reviews (with homogeneity) of randomised controlled trials.

Briel M, Studer M, Glass TR, Bucher HC. Effects of statins on stroke prevention in patients with and without coronary heart disease: a meta-analysis of randomized controlled trials. Am J Med 2004;117: 596-606.

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  • * Patient-Oriented Evidence that Matters. See editorial (BMJ 2002;325: 983

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