Effects of statins on stroke prevention in patients with and without coronary heart disease: A meta-analysis of randomized controlled trials
Section snippets
Methods
MEDLINE, EMBASE, Pascal, Index Medicus, and the Cochrane Library were searched without language restrictions to identify all randomized controlled trials published through August 2002 that compared dietary or pharmaceutical lipid-lowering interventions with placebo or usual diet. We also searched previously published meta-analyses and reference lists of identified publications for citations of additional relevant articles up to June 2003. The original study investigators were contacted for
Results
We identified 120 randomized controlled trials that tested lipid-lowering interventions and reported mortality data. Clinical outcomes of four completed trials are not yet published (86, 87, 88, 89). Of the remaining 116 trials, 69 provided data on the incidence of nonfatal and fatal stroke and had a minimum follow-up of 6 months. Four trials were excluded because they were restricted to patients who had previous strokes (13, 14), received hormone therapy (15), or undergone ileal bypass surgery
Discussion
This systematic review suggests that statins may reduce fatal and nonfatal strokes in hyperlipidemic patients with or without pre-existing coronary heart disease. The number needed to treat to prevent one stroke per year with statins is 617 in patients with established coronary heart disease (based on an annual stroke risk of 0.9%) and 2778 in those without established coronary heart disease (based on an annual stroke risk of 0.2%). These effects are moderate but statistically significant,
Acknowledgment
We would like to thank P. Wolf for performing the literature search, C. Schindler for statistical advice, and the authors who contributed unpublished data from their trials.
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