Statines et prévention des accidents vasculaires cérébraux

Statins have become a leading prescription drug in France. Indications have been greatly extended over the last five years subsequent to publication of many multicentric prospective trials. Besides their preventive properties for coronary artery disease, their efficacy for the prevention of stroke also appears to be demonstrated in coronary patients (CARE and LIPID studies) and in subjects at risk (HPS and ASCOT-LLA studies) irrespective of the serum cholesterol level, the relative risk of stroke being decreased by 30 percent compared with placebo. This preventive capacity would involve pathways other than cholesterol and/or LDL-cholesterol lowering mechanisms, and would probably involve a direct effect on inflammation, coagulation, modulation of certain atherogenic processes, and endothelial function. There remains however certain questions concerning the exact role of statins on secondary prevention of stroke (SPARCL study), their real usefulness in the elderly subject (PROSPER study), and the relative superiority of individual statins.