Byington R P, Davis B R, Plehn J F, White H D, Baker J, Cobbe S M, Shepherd J
Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
Circulation. 2001 Jan 23;103(3):387-92. doi: 10.1161/01.cir.103.3.387.
Stroke is a leading cause of death and disability. Although clinical trials of the early lipid-lowering therapies did not demonstrate a reduction in the rates of stroke, data from recently completed statin trials strongly suggest benefit.
The effect of pravastatin 40 mg/d on stroke events was investigated in a prospectively defined pooled analysis of 3 large, placebo-controlled, randomized trials that included 19 768 patients with 102 559 person-years of follow-up. In all, 598 participants had a stroke during approximately 5 years of follow-up. The 2 secondary prevention trials (CARE [Cholesterol And Recurrent Events] and LIPID [Long-term Intervention with Pravastatin in Ischemic Disease]) individually demonstrated reductions in nonfatal and total stroke rates. When the 13 173 patients from CARE and LIPID were combined, there was a 22% reduction in total strokes (95% CI 7% to 35%, P:=0.01) and a 25% reduction in nonfatal stroke (95% CI 10% to 38%). The beneficial effect of pravastatin on total stroke was observed across a wide range of patient characteristics. WOSCOPS (West of Scotland Coronary Prevention Study, a primary prevention trial in hypercholesterolemic men) exhibited a similar, although smaller, trend for a reduction in total stroke. Among the CARE/LIPID participants, pravastatin was associated with a 23% reduction in nonhemorrhagic strokes (95% CI 6% to 37%), but there was no statistical treatment group difference in hemorrhagic or unknown type.
Pravastatin reduced the risk of stroke over a wide range of lipid values among patients with documented coronary disease. This effect was due to a reduction in nonfatal nonhemorrhagic strokes.
中风是导致死亡和残疾的主要原因。尽管早期降脂疗法的临床试验未显示中风发生率降低，但近期完成的他汀类药物试验数据强烈提示有益处。
在一项前瞻性定义的汇总分析中，对3项大型、安慰剂对照、随机试验进行了研究，以探讨40mg/d普伐他汀对中风事件的影响。这3项试验共纳入19768例患者，随访时间达102559人年。在约5年的随访期内，共有598名参与者发生中风。两项二级预防试验（胆固醇与再发事件研究[CARE]和缺血性疾病普伐他汀长期干预研究[LIPID]）各自显示非致死性中风和总中风发生率降低。当将CARE和LIPID研究中的13173例患者合并分析时，总中风发生率降低了22%（95%可信区间为7%至35%，P=0.01），非致死性中风发生率降低了25%（95%可信区间为10%至38%）。在广泛的患者特征范围内均观察到普伐他汀对总中风的有益作用。西苏格兰冠心病预防研究（WOSCOPS，一项针对高胆固醇血症男性的一级预防试验）在总中风降低方面呈现出类似趋势，尽管幅度较小。在CARE/LIPID研究的参与者中，普伐他汀使非出血性中风发生率降低了23%（95%可信区间为6%至37%），但在出血性或不明类型中风方面，治疗组间无统计学差异。
在有冠心病记录的患者中，普伐他汀在广泛的血脂水平范围内降低了中风风险。这种作用归因于非致死性非出血性中风的减少。
