Crouse J R, Byington R P, Hoen H M, Furberg C D
Department of Medicine, Bowman Gray School of Medicine, Winston-Salem, NC, USA.
Arch Intern Med. 1997 Jun 23;157(12):1305-10.
Epidemiologic evidence and meta-analyses of data from early clinical trials suggest that lowering the levels of cholesterol does not reduce the events of stroke. These analyses have not included more recent clinical trials using reductase inhibitors.
To conduct a meta-analysis of the effect of reducing cholesterol levels on stroke in all reported clinical trials of primary (n = 4) and secondary (n = 8) prevention of coronary heart disease that used reductase inhibitor monotherapy and provided information on incident stroke.
Analysis of combined data from primary and secondary prevention trials showed a highly statistically significant reduction of stroke associated with the use of reductase inhibitor monotherapy (27% reduction in stroke; P = .001). Analysis of secondary prevention trials alone disclosed a similar statistically significant effect (32% reduction in stroke; P = .001). A smaller nonsignificant reduction in stroke was noted in the primary prevention trials (15% reduction in stroke; P = .48).
Reductase inhibitors now in use for lowering cholesterol levels are more potent and have fewer side effects than the cholesterol-lowering agents previously available. They appear to reduce stroke, most notably in patients with prevalent coronary artery disease, which may be partly due to the effects of lowering the levels of cholesterol on the progression and plaque stability of extracranial carotid atherosclerosis or the marked reduction of incident coronary heart disease associated with treatment.
早期临床试验的流行病学证据和数据荟萃分析表明，降低胆固醇水平并不能减少中风事件。这些分析未纳入使用还原酶抑制剂的近期临床试验。
对所有已报道的使用还原酶抑制剂单药治疗并提供中风事件信息的冠心病一级预防（n = 4）和二级预防（n = 8）临床试验中降低胆固醇水平对中风影响进行荟萃分析。
对一级和二级预防试验的合并数据进行分析显示，使用还原酶抑制剂单药治疗与中风显著减少具有高度统计学意义（中风减少27%；P = 0.001）。仅对二级预防试验进行分析也显示出类似的统计学显著效果（中风减少32%；P = 0.001）。在一级预防试验中，中风有较小的非显著减少（中风减少15%；P = 0.48）。
目前用于降低胆固醇水平的还原酶抑制剂比以前可用的降胆固醇药物更有效且副作用更少。它们似乎能减少中风，在患有冠状动脉疾病的患者中最为明显，这可能部分归因于降低胆固醇水平对颅外颈动脉动脉粥样硬化进展和斑块稳定性的影响，或与治疗相关的冠心病事件显著减少。
