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February 22, 2000; 54 (4) Views & Reviews

HMG-CoA reductase inhibitors (statins)

A promising approach to stroke prevention

David C. Hess, Andrew M. Demchuk, Lawrence M. Brass, Frank M. Yatsu
First published February 22, 2000, DOI: https://doi.org/10.1212/WNL.54.4.790
David C. Hess
MD
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Andrew M. Demchuk
MD, FRCPC
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Lawrence M. Brass
MD
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Frank M. Yatsu
MD
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Citation
HMG-CoA reductase inhibitors (statins)
A promising approach to stroke prevention
David C. Hess, Andrew M. Demchuk, Lawrence M. Brass, Frank M. Yatsu
Neurology Feb 2000, 54 (4) 790-796; DOI: 10.1212/WNL.54.4.790

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Abstract

Article abstract Statins represent a promising class of agents to prevent stroke. In randomized trials of middle-aged patients with coronary artery disease, statins reduce the incidence of stroke. The reduction in stroke may not be solely related to cholesterol or low-density lipoprotein reduction but may involve nonsterol mechanisms effects on endothelial cells, macrophages, platelets, and smooth muscle cells. Statins also reduce the size of cerebral infarction in a murine stroke model, suggesting a neuroprotective effect. The best current evidence for stroke prevention is with pravastatin and simvastatin. Pravastatin reduces the risk of stroke in patients with coronary artery disease and average cholesterol levels; simvastatin reduces the risk of the combined endpoint of stroke and transient ischemic attack in hypercholesterolemic patients with coronary artery disease. Future studies of statins are needed in stroke populations, particularly the elderly.

  • Received July 23, 1999.
  • Accepted September 28, 1999.
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  • Article
    • Abstract
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    • Mechanisms of action of statins.
    • Future directions.
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