Reduction of stroke events with pravastatin: the Prospective Pravastatin Pooling (PPP) Project.
BACKGROUND
Stroke is a leading cause of death and disability. Although clinical trials of the early lipid-lowering therapies did not demonstrate a reduction in the rates of stroke, data from recently completed statin trials strongly suggest benefit.


RESULTS
The effect of pravastatin 40 mg/d on stroke events was investigated in a prospectively defined pooled analysis of 3 large, placebo-controlled, randomized trials that included 19 768 patients with 102 559 person-years of follow-up. In all, 598 participants had a stroke during approximately 5 years of follow-up. The 2 secondary prevention trials (CARE [Cholesterol And Recurrent Events] and LIPID [Long-term Intervention with Pravastatin in Ischemic Disease]) individually demonstrated reductions in nonfatal and total stroke rates. When the 13 173 patients from CARE and LIPID were combined, there was a 22% reduction in total strokes (95% CI 7% to 35%, P:=0.01) and a 25% reduction in nonfatal stroke (95% CI 10% to 38%). The beneficial effect of pravastatin on total stroke was observed across a wide range of patient characteristics. WOSCOPS (West of Scotland Coronary Prevention Study, a primary prevention trial in hypercholesterolemic men) exhibited a similar, although smaller, trend for a reduction in total stroke. Among the CARE/LIPID participants, pravastatin was associated with a 23% reduction in nonhemorrhagic strokes (95% CI 6% to 37%), but there was no statistical treatment group difference in hemorrhagic or unknown type.


CONCLUSIONS
Pravastatin reduced the risk of stroke over a wide range of lipid values among patients with documented coronary disease. This effect was due to a reduction in nonfatal nonhemorrhagic strokes.
Byington
R P
RP
Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA. bbyingto@wfubmc.edu
Davis
B R
BR
Plehn
J F
JF
White
H D
HD
Baker
J
J
Cobbe
S M
SM
Shepherd
J
J
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D017035:Pravastatin / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000401:mortality / Q000517:prevention & control*; D013997:Time Factors
D000924:Anticholesteremic Agents; D017035:Pravastatin