Lipid management in the prevention of stroke: review and updated meta-analysis of statins for stroke prevention

Lancet Neurol. 2009 May;8(5):453-63. doi: 10.1016/S1474-4422(09)70058-4.


Despite the inconsistent or weak association between cholesterol and stroke, lowering of cholesterol concentrations with statins reduces the risk of stroke in high-risk populations and in patients with non-cardioembolic stroke or transient ischaemic attack. Statin therapy is the most important advance in stroke prevention since the introduction of aspirin and antihypertensive treatments. Meta-analysis of randomised trials of statins in combination with other preventive strategies, including 165 792 individuals, shows that each 1 mmol/L (39 mg/dL) decrease in LDL cholesterol equates to a reduction in relative risk for stroke of 21.1% (95% CI 6.3-33.5, p=0.009). In secondary prevention of non-cardioembolic stroke, intense reduction of LDL cholesterol by statins also significantly reduced the risk of recurrent stroke (relative risk 0.84, 0.71-0.99, p=0.03) and major cardiovascular events (0.80, 0.69-0.92, p=0.002). Future directions include assessment of a target LDL cholesterol concentration of less than 1.8 mmol/L (70 mg/dL), the effects of triglyceride-lowering therapy alone or in combination with statins, and the effects of treatments to raise HDL cholesterol concentrations.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Aged
  • Cholesterol, LDL / blood*
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Intracranial Hemorrhages / prevention & control
  • Male
  • Middle Aged
  • Randomized Controlled Trials as Topic
  • Regression Analysis
  • Risk Factors
  • Secondary Prevention
  • Stroke / mortality
  • Stroke / prevention & control*
  • Stroke / therapy


  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors