Stroke: statin drugs decrease stroke and death.

Clinical bottom line (level 1a)

  1. Patients who are risk of stroke or with high cholesterol who are given statin drugs, are less likely to have a stroke than those given placebo (NNT = 177 at unknown) , and have reduced mortality rates (NNT = 89 at unknown) .
  2. Patients who have had a stroke and are given statin drugs, are less likely to have another stroke than those given placebo (NNT = 138 at unknown) and also have lower mortality rates (NNT = 81 at unknown) .
  3. Patients at risk of stroke or with high cholesterol who are given statin drugs are less likely to have a cardiovascular death than those with placebo (NNT = 98 at unknown)
Hebert et al: Journal of the American Medical Association 1997; 278: 313-321
Expires November 2003

The study

Systematic review of randomised trials of
  • Patients: at risk of stroke or high cholesterol
  • Intervention: statin drugs compared with placebo
  • Outcome: risk of stroke and mortality


    • Articles found in English using "computerised search", 1985 to 1995 (search terms: terms not given ) and searching of reference lists of published trials and previously conducted overviews. Principal investigators of the trials and their funding agencies were contacted to secure relevant data not included in the published reports.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: treatments involved concomitant use of other lipid-lowering drugs.

    16 trials were included.
    • The specific HMG-CoA reductase inhibitors used were lovastatin (6 studies), pravastatin (8) and simvastatin (2).

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NNT
    (95% CI)
    stroke death unknown 26/11875
    (0.22%)    		 1.17
    (0.69 to 1.97)     		-2681
    (NNT = 1469 to infinity;
    NNH = 471 to infinity)
    all stroke unknown 235/11875
    (1.98%)    		 0.71
    (0.59 to 0.86)     		177
    (125 to 367)
    stroke death- secondary prevention unknown 19/7900
    (0.24%)    		 1.28
    (0.71 to 2.32)     		-1493
    (NNT = 1439 to infinity;
    NNH = 317 to infinity)
    all stroke- secondary prevention unknown 182/7900
    (2.30%)    		 0.68
    (0.55 to 0.85)     		138
    (98 to 296)
    all deaths unknown 643/11995
    (5.36%)    		 0.78
    (0.69 to 0.88)     		89
    (63 to 163)
    cardiovascular disease death unknown 447/11995
    (3.73%)    		 0.72
    (0.63 to 0.84)     		98
    (74 to 173)
    all deaths- secondary prevention unknown 496/8020
    (6.18%)    		 0.79
    (0.69 to 0.91)     		81
    (55 to 191)
    cardiovascular deaths- secondary prevention unknown 365/8020
    (4.55%)    		 0.74
    (0.64 to 0.87)     		88
    (63 to 176)

    • Statin treatment had no clear effect on non-cardiovascular disease deaths.

    Citation

    1. Hebert PR, Gaziano JM, Chan KS: Cholesterol lowering with statin drugs, risk of stroke, and total mortality. Journal of the American Medical Association 1997; 278: 313-321
    Contributor: Clare Wotton and Musab Hayatli, November 1999
    Reviewer:

    Clinical Question.
    Patient at risk of stroke or high cholesterol
    Intervention or Exposure statin drugs
    Comparison placebo
    Outcome risk of stroke and mortality