The role of statins in the prevention of ischemic stroke

Statin treatment has been demonstrated to diminish the risk for stroke in patients with coronary heart disease, hypercholesterolemia, normocholesterolemia, in the elderly, and among hypertensive and diabetic patients. Stroke incidence in patients on statin treatment has been reduced in all these clinical settings involving both primary and secondary prevention but not in patients with previous stroke. Two recent meta-analyses confirm this conclusion. The mechanism by which statins provide benefit against stroke is likely multifactorial, involving both the low-density lipoprotein cholesterol-lowering effect with stabilization of vulnerable plaques, and pleiotropic effects such as improvement of endothelial function, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory responses, immunomodulatory actions, and regulation of progenitor cells.