Amarenco Pierre, Lavallée Philippa, Touboul Pierre-Jean
Department of Neurology and Stroke Centre, Bichat-Claude Bernard University Hospital and Medical School, Denis Diderot University-Paris VII, France.
Lancet Neurol. 2004 May;3(5):271-8. doi: 10.1016/S1474-4422(04)00734-3.
The risk of stroke increases with age, and hence the disease particularly affects the elderly, who are also at high risk for coronary heart disease. Epidemiological and observational studies have not shown a clear association between cholesterol concentrations and all causes of stroke. Large, long-term statin trials in patients with established or high risk for coronary heart disease have shown that statins decrease stroke incidence. These statin trials in a combined total of 70,020 patients indicate relative and absolute risk reductions for stroke of 21% and 0.9%, respectively. By comparison, the number of strokes prevented per 1000 patients treated for 5 years in patients with coronary heart disease is nine for statins versus 17.3 for antiplatelet drugs and 17 for antihypertensive drugs. Although the Heart Protection Study showed that statins lower the risk of major coronary events in patients with a previous stroke, statins may not lower stroke recurrence in these patients. In this review, we discuss the potential reasons for the effects of statins on stroke and the mechanisms of action. Treatment strategies on the basis of global cardiovascular risk may be most effective. Additional studies in patients representative of the typical stroke population are needed.
中风风险随年龄增长而增加，因此该疾病尤其影响老年人，而老年人也是冠心病的高危人群。流行病学和观察性研究尚未表明胆固醇浓度与所有中风病因之间存在明确关联。针对已确诊或有冠心病高风险患者开展的大型长期他汀类药物试验表明，他汀类药物可降低中风发病率。这些针对总计70020名患者的他汀类药物试验表明，中风的相对风险和绝对风险分别降低了21%和0.9%。相比之下，每1000名接受5年治疗的冠心病患者中，他汀类药物预防中风的人数为9例，而抗血小板药物为17.3例，降压药物为17例。尽管心脏保护研究表明他汀类药物可降低既往中风患者发生重大冠脉事件的风险，但他汀类药物可能无法降低这些患者的中风复发率。在本综述中，我们讨论了他汀类药物对中风产生影响的潜在原因及作用机制。基于全球心血管风险的治疗策略可能最为有效。需要针对典型中风人群的代表性患者开展更多研究。
