HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Correspondence: Submit a response Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Amarenco, P. Search for Related Content PubMed PubMed Citation Articles by Amarenco, P.

Hypercholesterolemia, lipid-lowering agents, and the risk for brain infarction

From the Department of Neurology Bichat Hospital, Rene Descartes University and Stroke Unit, Paris, France.

Address correspondence and reprint requests to Dr. Pierre Amarenco, Service de Neurologie, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France. Email: amarenco{at}ccr.jussieu.fr

Clinical trials in the 1990s using HMG-CoA reductase inhibitors (statins) showed that cholesterol-lowering treatment significantly reduces cardiovascular events including strokes in the primary and secondary prevention of myocardial infarction (MI). Paradoxically, the link between serum cholesterol level and the incidence of stroke remains to be fully established. This is largely due to conflicting evidence from a series of observational cohort studies and a suggestion that lowering serum cholesterol increased the risk for hemorrhagic stroke. These findings have tended to influence the treatment of stroke, despite alternative interpretations for the failure of these studies to find a clear association between cholesterol levels and stroke.

The statin trials present a strong argument for a reappraisal of the link between cholesterol and stroke. Three meta-analyses have all shown a relative risk reduction in stroke of 12 to 48% in patients with coronary heart disease (CHD) after MI. There was no statistically significant increase in hemorrhagic stroke. Recently, gemfibrozil has also been shown to reduce the relative risk for stroke (25%), which contradicts the findings of previous fibrate trials.

It is becoming clear that the clinical action of many cholesterol-lowering drugs is the result of pleiotropic/antiatherogenic effects rather than simply a reduction in cholesterol. There is also evidence that these agents exert direct effects that promote atherosclerotic plaque stability. After these observations, it is now generally accepted that lipid-lowering treatment should be considered in all stroke patients with a history of CHD/MI. However, for the remaining patients with ischemic stroke, there is no proven therapeutic approach, and several large randomized, placebo-controlled trials are under way or planned for this indication.

This article has been cited by other articles:

				T. S. Olsen, R. H. B. Christensen, L. P. Kammersgaard, and K. K. Andersen Higher Total Serum Cholesterol Levels Are Associated With Less Severe Strokes and Lower All-Cause Mortality: Ten-Year Follow-Up of Ischemic Strokes in the Copenhagen Stroke Study Stroke, October 1, 2007; 38(10): 2646 - 2651. [Abstract] [Full Text] [PDF]

				B. Fletcher, K. Berra, P. Ades, L. T. Braun, L. E. Burke, J. L. Durstine, J. M. Fair, G. F. Fletcher, D. Goff, L. L. Hayman, et al. Managing Abnormal Blood Lipids: A Collaborative Approach Circulation, November 15, 2005; 112(20): 3184 - 3209. [Abstract] [Full Text] [PDF]

				P. Amarenco Lipid lowering and recurrent stroke: another stroke paradox? Eur. Heart J., September 2, 2005; 26(18): 1818 - 1819. [Full Text] [PDF]

				P. Amarenco, J. Labreuche, P. Lavallee, and P.-J. Touboul Statins in Stroke Prevention and Carotid Atherosclerosis: Systematic Review and Up-to-Date Meta-Analysis Stroke, December 1, 2004; 35(12): 2902 - 2909. [Abstract] [Full Text] [PDF]

				P. Amarenco and A. M. Tonkin Statins for Stroke Prevention: Disappointment and Hope Circulation, June 15, 2004; 109(23_suppl_1): III-44 - III-49. [Abstract] [Full Text] [PDF]

				J. Marti-Fabregas, M. Gomis, A. Arboix, A. Aleu, J. Pagonabarraga, R. Belvis, D. Cocho, J. Roquer, A. Rodriguez, M. D. Garcia, et al. Favorable Outcome of Ischemic Stroke in Patients Pretreated with Statins Stroke, May 1, 2004; 35(5): 1117 - 1121. [Abstract] [Full Text] [PDF]

				G. Zuliani, A. Cherubini, A. R. Atti, A. Ble, C. Vavalle, F. Di Todaro, C. Benedetti, S. Volpato, M. G. Marinescu, U. Senin, et al. Low Cholesterol Levels Are Associated With Short-Term Mortality in Older Patients With Ischemic Stroke J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2004; 59(3): M293 - M297. [Abstract] [Full Text] [PDF]

				D. Deplanque, P. Gele, O. Petrault, I. Six, C. Furman, M. Bouly, S. Nion, B. Dupuis, D. Leys, J.-C. Fruchart, et al. Peroxisome Proliferator-Activated Receptor-{alpha} Activation as a Mechanism of Preventive Neuroprotection Induced by Chronic Fenofibrate Treatment J. Neurosci., July 16, 2003; 23(15): 6264 - 6271. [Abstract] [Full Text] [PDF]

				B. T Yim and P. H Chong Niacin-ER and Lovastatin Treatment of Hypercholesterolemia and Mixed Dyslipidemia Ann. Pharmacother., January 1, 2003; 37(1): 106 - 115. [Abstract] [Full Text] [PDF]

				W. Lalouschek, W. Lang, S. Greisenegger, and M. Mullner Determination of Lipid Profiles and Use of Statins in Patients With Ischemic Stroke or Transient Ischemic Attack Stroke, January 1, 2003; 34(1): 105 - 110. [Abstract] [Full Text] [PDF]