Risks of statins. In 1 study involving 35,000 participants and 158,000 person-years of observation, there were 8 cases of rhabdomyolysis in the treatment groups vs 5 in the placebo groups.7 Forty-three deaths attributed to statin therapy have been reported to the Food and Drug Administration from 1987 to 2001, or 1 per million person-years of use. The Heart Protection Study found simvastatin and placebo users reported myopathy or muscle pain at the same annual rate of 0.01%.
Recommendations from others
We found no recommendations specifically regarding the use of statins to prevent stroke. However, the Third Report of the National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATP III) describes symptomatic carotid artery disease as a coronary heart disease risk equivalent and recommends therapy to reduce the LDL below 100 mg/dL.8
CLINICAL COMMENTARY
Statins prevent cerebrovascular accidents and have low adverse event rates
Alex Krist, MD
Fairfax Family Practice Residency, Virginia Commonwealth University, Fairfax
Statins are effective for primary and tertiary cardiovascular disease prevention. For those with vascular disease or significant risks, statins prevent cerebrovascular accidents and have low adverse event rates.
While no evidence is available about primary prevention of cerebrovascular accidents for those at lower risk, in practice statins are often appropriately initiated. NCEP-ATP III,8 the key guideline on when to start statins, is based more on cardiac benefits. Most studies evaluating statins use a triple outcome of mortality, myocardial infarction, or cerebrovascular accident. Since myocardial infarction is more common than the other adverse endpoints, there is a greater demonstrated cardioprotective effect (prevention of myocardial infarction: NNT=95; prevention of cerebrovascular accidents: NNT=735).9 However, regardless of whether the benefits are cardiac or cerebrovascular, statins will prevent disease for many patients.