Stroke: statin monotherapy decreases secondary stroke.

Clinical bottom line (level 1a)

  1. Patients with coronary heart disease who are given statin monotherapy are less likely to have a stroke, than those given placebo (NNT = 147 at unknown) .
  2. Patients with a previous stroke who are given statin monotherapy are less likely to have another than those given placebo (NNT = 100 at unknown) .
  3. Patients at risk of a primary stroke have no clear difference in stroke rates.
Crouse III et al: Archives of Internal Medicine 1997; 157: 1305-1310
Expires November 2002

The study

Systematic review of clinical trials of
  • Patients: at risk of a stroke
  • Intervention: reductase inhibitor monotherapy compared with placebo
  • Outcome: cardiovascular events


Articles found in ? using MEDLINE, ? (search terms: search terms not given ) and reviewing citations in reports of recent clinical trials.

Selection criteria: as above
Appraisal criteria: not detailed
Articles excluded if: medication in addition to reductase inhibitors used

12 trials were included, with duration of around 5 years
  • 4 trials involved primary prevention of coronary heart disease and 8 were secondary prevention trials
  • The treatments used were pravastatin monotherapy (8 studies), lovastatin monotherapy (3) and simvastatin monotherapy (1).

The evidence

Outcome Time to outcome CEREERRRR
(95% CI)		ARR
(95% CI)		NNT
(95% CI)
stroke (primary and secondary prevention trials) unknown 248
(2.54%)		 182
(1.86%)		 27.0%
(12.0% to 39.0%)		 0.68%
(0.27% to 1.09%)		 147
(91 to 371)
stroke (primary prevention only) unknown 56
(1.44%)		 48
(1.23%)		 14.0%
(-25.0% to 42.0%)		 0.21%
(-0.30% to 0.72%)		 482
(NNT = 140 to infinity;
NNH = 332 to infinity)
stroke (secondary prevention only) unknown 192
(3.28%)		 134
(2.29%)		 30.0%
(13.0% to 44.0%)		 1.00%
(0.40% to 1.59%)		 100
(63 to 249)

  • The odds ratio for stroke difference in stroke number for the combined primary and secondary prevention trials was 0.73.

Citation

  1. Crouse III JR, Byington RP, Hoen HM, et al: Reductase inhibitor monotherapy and stroke prevention. Archives of Internal Medicine 1997; 157: 1305-1310
Contributor: Clare Wotton and Musab Hayatli, November 1999
Reviewer: Santiago Alvarez Montero

Clinical Question.
    Patient at risk of a stroke
    Intervention or Exposure reductase inhibitor monotherapy
    Comparison placebo
    Outcome stroke