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 .
Dr.S.Venkatesan MD 