April 30, 2009

Managing Blood Pressure, Cholesterol Cuts Stroke Risk

THURSDAY, April 30 (HealthDay News) -- People who have suffered a stroke can significantly reduce the odds of a second stroke or a heart attack by controlling their blood pressure and cholesterol, new research shows.

"There are about 800,000 new strokes in the U.S. and 1 million in Europe each year," said study author Dr. Pierre Amarenco, of Denis Diderot University and Medical School in Paris. "Among them, between 5 and 10 percent will have a recurrent stroke and about 2 percent will have a myocardial infarction."

For the study, researchers followed 4,731 people who had suffered a stroke or "mini-stroke." Half of the patients received the cholesterol-lowering drug atorvastatin (Lipitor), while half received a placebo. Pfizer Inc., which makes Lipitor, funded the study.

The researchers found that over an average of 4.9 years, patients who maintained optimal levels of LDL ("bad") cholesterol, HDL ("good") cholesterol, triglycerides and blood pressure were significantly less likely to suffer a secondary stroke or other cardiovascular problems. The findings were presented Wednesday at the American Academy of Neurology's annual meeting in Seattle.

"In this study, we show that lowering LDL cholesterol is important to reduce the burden of new stroke and myocardial infarction," Amarenco said. "When all four targets were achieved in the SPARCL [Stroke Prevention by Aggressive Reduction in Cholesterol Levels] trial, there was a 75 percent reduction in stroke, myocardial infarction and vascular death."

Despite the promising results, many physicians are concerned about the possible ramifications, both physical and societal, resulting from long-term statin use.

"There is a great worry by all of us that there could be long-term adverse effects from high-dose statins that has not yet been seen," said Dr. Matthew Fink, chief of the division of stroke and critical care neurology at Weill Cornell Medical College in New York City, who adds that HDL levels can be increased naturally through exercise.

For the time being, most researchers agree that it's important to closely monitor patients taking statins.

"Does in-practice therapeutic education of patients with stroke and close monitoring by prevention nurses [nurse practitioners] help patients implement guidelines and make sure they achieve targets to reduce their risk close to the 75 percent we have observed?" asked Amarenco. "The polypill concept is a dream, but therapeutic education and monitoring by nurse practitioners is achievable."

Even if statins prove to be safe when used over the long-term, questions remain about their relatively high cost for much of the world's population.

"What about cost benefit?" Fink asked. "These are expensive drugs, and what happens around the world where people simply can't pay for them?"

More information

Visit the National Institutes of Health for more information on stroke.

SOURCES: Pierre Amarenco, M.D., Denis Diderot University and Medical School, Paris, and fellow, American Academy of Neurology; Matthew Fink, M.D., chief, division of stroke and critical care neurology, Weill Cornell Medical College, New York City; April 29, 2009, presentation, American Academy of Neurology annual meeting, Seattle
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