A Cochrane review «Interventions in the management of serum lipids for preventing stroke recurrence»1 «Manktelow BN, Potter JF. Interventions in the management of serum lipids for preventing stroke recurrence. Cochrane Database Syst Rev 2009;(3):CD002091. . »1 included 8 studies with approximately 10 000 patients with a history of stroke or transient ischaemic attack (TIA). The lipid-lowering interventions were pravastatin (2 studies), atorvastatin (1 study), simvastatin (2 studies), clofibrate (2 studies), and conjugated oestrogen (1 study). The follow-up ranged from 90 days (1 study) to 6 years. Lipid-lowering therapies had no effect on stroke recurrence (OR 0.92, 95% CI 0.81 to 1.04) but statins alone had a marginal benefit in reducing subsequent cerebrovascular events (OR 0.88, 95% CI 0.77 to 1.00). However, there was evidence for a protective effect of statins for ischaemic stroke (OR 0.78, 95% CI 0.67 to 0.92) but for an increased risk of haemorrhagic stroke (OR 1.72, 95% CI 1.20 to 2.46). There was no evidence that any lipid lowering therapy reduced all-cause mortality or sudden death (OR 1.00, 95% CI 0.83 to 1.20; 3 studies). Three statin trials showed a reduction in subsequent serious vascular events (non-fatal stroke, non-fatal myocardial infarction, vascular death; OR 0.74, 95% CI 0.67 to 0.82).
Comment: The quality of evidence is downgraded by indirectness (data used here from three large studies are sub-group analyses from the trials).