Dr.S.Venkatesan MD

When know   statins have  revolutionised  the management of  coronary artery disease , why  we  hesitate  to  say   the same thing    for  cerebro vascular disease ?

Is it because

       Atherosclerosis is different in  cerebrovascular disease   than coronary artery  disease

 or  Blood pressure control  becomes more important in preventing stroke than lipids?

Unlike  MI ,  Cerebro vascular system   have   variety of insults.

• Embolic stroke
• Thrombotic stroke
• Ischemic stroke
• Hemorrhagic stroke
• Low flow – Water shed infarcts

Hemorrhagic , embolic and low flow mediated  myocardial infarction are very rare and  denova hemorrhagic MI is non existent.This is due  to  the fact ,  coronary autoregulation is  vastly different from cerebral vessels. Carotid plaque stabilisation  is a  major mechanism by which statins can prevent stroke . Still , statin  therapy( however aggressive)  has less impact  in the incidence  of stroke than MI.

This meta analysis claims statin to be very  effective  in prevention of ischemic stroke.

We have observed  ,simple statin administration without concomitant BP reduction has absolutely no effect on stroke prevention,   while  in  coronary  prevention even if the blood pressure optimisation is less than the desired levels,  significant number of  MI are still  prevented.

http://www.ncbi.nlm.nih.gov/pubmed/18187070

 The  SPARCL  trial  was big boost  for   statin   industry  in widening the Indication  for stroke prevention

Final message

Does statins remain a suspect in stroke prevention ?

If we  accept the  saying   ” Data won’t lie ” . .  . the suspicion  about  statins  is  a myth.

High dose Atorvastatin 80mg /day should be prescribed for every one with at high risk for ischemic stroke .