Goldstein Larry B
Duke Center for Cerebrovascular Disease, Stroke Policy Program, Center for Clinical Health Policy Research, Box 3651, Duke University Medical Center, Durham, NC 27710, USA.
Curr Atheroscler Rep. 2007 Oct;9(4):305-11. doi: 10.1007/s11883-007-0037-0.
Unlike coronary heart disease, epidemiologic studies find a weak and inconsistent relationship between cholesterol levels and overall stroke risk. There does, however, appear to be a positive relationship between total and low-density lipoprotein cholesterol levels and the risk of ischemic stroke, with an inverse relationship between cholesterol levels and hemorrhagic stroke. Treatment with statins is associated with the reduction in the risk of a first stroke in various populations of patients at increased risk of cardiovascular events. Treatment of patients with prior cerebrovascular disease is associated with a reduction in major cardiovascular events and, in a single study, with a reduction in fatal and nonfatal stroke in patients with prior stroke or transient ischemic attack and no known coronary heart disease. Whether the benefit of statins in reducing the risk of stroke is due to their potent lipid-lowering effects, pleiotropic effects, or a combination of the two cannot be determined based on data available from clinical trials.
与冠心病不同，流行病学研究发现胆固醇水平与总体中风风险之间的关系微弱且不一致。然而，总胆固醇和低密度脂蛋白胆固醇水平与缺血性中风风险之间似乎存在正相关关系，而胆固醇水平与出血性中风之间存在负相关关系。在心血管事件风险增加的各类患者群体中，使用他汀类药物进行治疗与首次中风风险的降低相关。对既往有脑血管疾病的患者进行治疗与主要心血管事件的减少相关，并且在一项研究中，对于既往有中风或短暂性脑缺血发作且无已知冠心病的患者，治疗可降低致命性和非致命性中风的发生率。基于临床试验可得的数据，无法确定他汀类药物降低中风风险的益处是归因于其强大的降脂作用、多效性作用还是两者的结合。
