Risk factors for non-haemorrhagic stroke in patients with coronary heart disease and the effect of lipid-modifying therapy with pravastatin.
OBJECTIVE
To determine the relative importance of recognised risk factors for non-haemorrhagic stroke, including serum cholesterol and the effect of cholesterol-lowering therapy, on the occurrence of non-haemorrhagic stroke in patients enrolled in the LIPID (Long-term Intervention with Pravastatin in Ischaemic Disease) study.


METHODS
The LIPID study was a placebo-controlled, double-blind trial of the efficacy on coronary heart disease mortality of pravastatin therapy over 6 years in 9014 patients with previous acute coronary syndromes and baseline total cholesterol of 4-7 mmol/l. Following identification of patients who had suffered non-haemorrhagic stroke, a pre-specified secondary end point, multivariate Cox regression was used to determine risk in the total population. Time-to-event analysis was used to determine the effect of pravastatin therapy on the rate of non-haemorrhagic stroke.


RESULTS
There were 388 non-haemorrhagic strokes in 350 patients. Factors conferring risk of future non-haemorrhagic stroke were age, atrial fibrillation, prior stroke, diabetes, hypertension, systolic blood pressure, cigarette smoking, body mass index, male sex and creatinine clearance. Baseline lipids did not predict non-haemorrhagic stroke. Treatment with pravastatin reduced non-haemorrhagic stroke by 23% (P = 0.016) when considered alone, and 21% (P = 0.024) after adjustment for other risk factors.


CONCLUSIONS
The study confirmed the variety of risk factors for non-haemorrhagic stroke. From the risk predictors, a simple prognostic index was created for non-haemorrhagic stroke to identify a group of patients at high risk. Treatment with pravastatin resulted in significant additional benefit after allowance for risk factors.
West
Malcolm J
MJ
Prince Charles Hospital, Brisbane, Australia. malcolm.west@mailbox.uq.edu.au
White
Harvey D
HD
Simes
R John
RJ
Kirby
Adrienne
A
Watson
John D
JD
Anderson
Neil E
NE
Hankey
Graeme J
GJ
Wonders
Susan
S
Hunt
David
D
Tonkin
Andrew M
AM
D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D003327:Coronary Disease / Q000150:complications* / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017035:Pravastatin / Q000627:therapeutic use*; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000517:prevention & control
D000924:Anticholesteremic Agents; D017035:Pravastatin