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Cholesterol Lowering and the Risk of Stroke

Bradley S. Boop, MD; Robert G. Hart, MD; David G. Sherman, MD
Arch Intern Med. 1996;156(2):214-215. doi:10.1001/archinte.1996.00440020124019.
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We welcomed the review of stroke in trials of cholesterol lowering by Hebert et al1 and agree both with their caution on interpreting these data and with their call for further clinical trials. Although the authors concluded that there was no benefit of cholesterol lowering for reduction of stroke, two recent studies offer contradictory evidence (Table). The Scandinavian Simvastatin Survival Study included patients with angina or previous myocardial infarction and total serum cholesterol concentrations of 5.5 to 8.0 mmol/L (212 to 308 mg/dL).2 Patients were randomized to a hydroxymethylglutaryl coenzyme A reductase

inhibitor or placebo and were followed up for more than 5 years. A 25% reduction in total cholesterol and a 35% reduction in low-density lipoprotein (LDL) cholesterol in the treated group was associated with a significant reduction in all-cause mortality, coronary events, and ischemic stroke. Ischemic strokes categorized as "nonembolic" (not defined) were reduced by about


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