Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022;56(4):240-249.
doi: 10.1159/000525672. Epub 2022 Jun 26.

Statin Therapy for Preventing Recurrent Stroke in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohort Studies

Yue Yin  1 , Li Zhang  1 , Iain Marshall  1 , Charles Wolfe  1   2   3 , Yanzhong Wang  1   2   3
Affiliations
Meta-Analysis

Statin Therapy for Preventing Recurrent Stroke in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohort Studies

Yue Yin et al. Neuroepidemiology. 2022.

Abstract

Introduction: Statins are effective in preventing vascular disease and are widely recommended and used for the secondary prevention of ischemic stroke. However, there is concern from trials that statins might increase the risk of hemorrhagic stroke, partially reducing their benefit. We sought to systematically review the latest evidence on this question.

Methods: Four electronic databases were searched to identify published randomized controlled trials (RCTs) and observational cohort studies (search date December 2020). Two independent reviewers carried out the eligibility assessment based on predefined inclusion criteria. We examined the outcomes of recurrent stroke (after ischemic stroke) of any type, and separately recurrent ischemic stroke and recurrent hemorrhagic stroke. RCTs and observational cohort studies were meta-analyzed separately. Odds ratios (ORs) were used to assess the effect of statin therapy. Meta-analysis was conducted using RevMan 5.4 software.

Results: We retrieved 559 papers in searches, of which 11 RCTs and 12 observational cohort studies were included. Both RCTs and observational studies found that statins reduced the odds of stroke of any type in those with an initial ischemic stroke (11 RCTs: OR = 0.87, 95% CI [0.77,0.97]; p = 0.02; 12 cohort studies: OR = 0.80, 95% CI [0.66, 0.96]; p = 0.02). Both RCTs and observational studies found that recurrence of ischemic stroke was reduced by statins (6 RCTs: OR = 0.81, 95% CI [0.70, 0.93]; p = 0.002; 3 observational studies: OR = 0.67, 95% CI [0.61, 0.75]; p < 0.00001). Data from 7 RCTs and 8 cohort studies did not find a significant difference in hemorrhagic stroke but could not rule out a substantial increase or reduction (7 RCTs: OR = 1.15, 95% CI [0.62, 2.13]; p = 0.66; 8 cohort studies: OR = 0.93, 95% CI [0.71, 1.21]; p = 0.59).

Conclusions: In people who have experienced an ischemic stroke, statins reduce the risk of recurrent stroke of any type medicated through a reduction of ischemic stroke. We found no increase in the risk of hemorrhagic stroke.

Keywords: Hemorrhagic stroke; Ischemic stroke; Statin treatment; Stroke recurrence.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
PRISMA flowchart. Study selection for RCTs.
Fig. 2
Fig. 2
PRISMA flowchart. Study selection for observational studies.
Fig. 3
Fig. 3
Forest plot of 11 RCTs for any type of recurrent stroke.
Fig. 4
Fig. 4
Forest plot of 12 cohort studies for any type of recurrent stroke.
Fig. 5
Fig. 5
Forest plot of 6 RCTs for recurrent IS.
Fig. 6
Fig. 6
Forest plot of 3 cohort studies for recurrent IS.
Fig. 7
Fig. 7
Forest plot of 7 RCTs for recurrent hemorrhagic stroke.
Fig. 8
Fig. 8
Forest plot of 8 cohort studies for recurrent hemorrhagic stroke.
See this image and copyright information in PMC

References

    1. World Health Organisation The top 10 causes of death [Internet] 2021. [cited 25 October 2021]. Available from https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.
    1. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JB, Culebras A, et al. An updated definition of stroke for the 21st century. Stroke. 2013 Jul;44((7)):2064–89. - PMC - PubMed
    1. Palacio S, Hart RG. Regarding article “guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart association/American stroke association”. Stroke. 2011 Dec;42((2)):e23. - PubMed
    1. Tramacere I, Boncoraglio GB, Banzi R, Del Giovane C, Kwag KH, Squizzato A, et al. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med. 2019 Mar;17((1)):67. - PMC - PubMed
    1. Amarenco P, Bogousslavsky J, Callahan A. High-dose atorvastatin after stroke or transient ischemic attack. J Vasc Surg. 2006 Aug;44((6)):1374. - PubMed

Publication types

MeSH terms

Substances