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Meta-Analysis
. 2014 Mar 18;9(3):e92388.
doi: 10.1371/journal.pone.0092388. eCollection 2014.

Statins for the prevention of stroke: a meta-analysis of randomized controlled trials

Wen Wang  1 , Bo Zhang  1
Affiliations
Meta-Analysis

Statins for the prevention of stroke: a meta-analysis of randomized controlled trials

Wen Wang et al. PLoS One. .

Abstract

Background: Stroke is a frequently encountered clinical event that has a detrimental impact on the quality of life. Evidence has increasingly shown that statins can substantially reduce the risk of coronary heart disease. However, it remains to be determined whether statins are definitively effective in preventing stroke.

Methods: We systematically searched the PubMed, Embase, and Central databases for studies that compared the effects of statins and placebo in patients at high risk for stroke. The outcome measures were overall incidence of stroke, incidence of fatal stroke, and incidence of hemorrhagic stroke.

Results: Eighteen randomized controlled trials satisfied all the inclusion criteria for the meta-analysis. The analysis revealed that statins reduced the overall incidence of stroke than placebo (odds ratio [OR]: 0.80; 95% confidence interval [CI]: 0.74-0.87; P<0.00001). In particular, statins showed efficacy in reducing the incidence of fatal stroke (OR: 0.90; 95% CI: 0.67-1.21; P = 0.47) and hemorrhagic stroke (OR: 0.87; 95% CI: 0.60-1.25; P = 0.45). On the contrary, they were found to increase the overall incidence of stroke (OR: 1.12; 95% CI: 0.89-1.41; P = 0.32) and fatal stroke (OR: 1.37; 95% CI: 0.93-2.03; P = 0.11) in renal transplant recipients and patients undergoing regular hemodialysis.

Conclusion: The results of this analysis suggest that statins may be beneficial in reducing the overall incidence of stroke and they may decrease the risk of fatal stroke and hemorrhagic stroke. However, statins should be used with caution in patients with a history of renal transplantation, regular hemodialysis, transient ischemic attack, or stroke. Further analyses should focus on multicentre, double-blind, placebo-controlled randomized trials with data stratification according to the nature of primary diseases and dose-effect relationship, to clarify the benefits of statins in protection against stroke.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flow chart indicating the selection process for this meta-analysis.
Figure 2
Figure 2. Risk of bias graph.
Figure 3
Figure 3. Risk of bias summary.
Figure 4
Figure 4. Forest plot for overall stroke incidence.
Figure 5
Figure 5. Forest plot for fatal stroke incidence.
Figure 6
Figure 6. Forest plot for hemorrhagic stroke incidence.
Figure 7
Figure 7. Funnel plot for 18 randomized controlled trials.
See this image and copyright information in PMC

References

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