Statins and stroke

Heart protection study showed benefit in patients with statins. LDL triggers macrophage transition to foam cells, promotes metalloproteinase production, inflammatory adhesion molecule expression, platelet adhesion, NO synthase.

Landau analysis/critique (Neurology, letter 73;817 2009)

risk reduction of atorvastatin for 72.5 year old was 0.4 % (NNT>200) from 3.3 to 2.9 %. this is annual second stroke risk. The risk of having a stroke for those not taking drug is 96.7%. Vital statistics show death rate from any cause is 3.2 % at age 72, 4.2 % at age 75, 6.7 at age 80, and 10.2 at age 85. Treatment group with atorvastatin had twice as many hemorrhagic strokes, larger death rate from all causes, and some occurrence of hepatotoxicity and rhabdomyolosis.

Michael Strupp (Munich) opined that the primary endpoint, risk of fatal aor nonfatal stroke, was reduced in treatment group by ten percent which was not significant. Bianchi et al. differentiated effects in younger and older patients. They compared in SPARCL the 25 % reduction in younger patients, the 10 % reduction in older patients, and lack of significant interaction between age and treatment group. They argued effect diminishes with age.