LIPID LOWERING DRUGS AND STROKE RISK
Alpérovitch A, Kurth T, Bertrand M, et al. Primary prevention with lipid lowering drugs and long term risk of vascular events in older people: population based cohort study. BMJ. 2015;350:h2335.
Statins and fibrates may reduce stroke risk by 30% in older adults with no history of vascular events, according to a population-based cohort study of 7,484 patients.
In a random sample of community-dwelling adults ages 65 and older, investigators calculated hazard ratios for use of any lipid-lowering drug, and for statin and fibrates separately, and found:
• Users of lipid-lowering drugs were at decreased risk for stroke compared with nonusers (hazard ratio [HR], 0.66).
• Statin users were at similarly decreased risk (HR, 0.68).
• Fibrate users were also at decreased risk (HR, 0.66).
• There was no association between lipid-lowering drug use and coronary heart disease (HR, 1.12).
COMMENTARY
This study supports the use of LDL cholesterol–lowering medication as primary prevention in older individuals to reduce the risk for stroke. The mean age in this study was 74. Previously, the PROSPER study—the only randomized study of older individuals with high vascular risk—showed that pravastatin reduced the risk for coronary disease but not for stroke.1 This study gives support that lowering cholesterol in older patients with elevated cholesterol can decrease their risk for stroke.
1. Shepherd J, Blauw GJ, Murphy MB, et al. Pravastatin in elderly individuals at risk for vascular disease (PROSPER). Lancet. 2002;360;1623-1630.
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