| Objective: stroke is a common clinical events which can cause permanent nerve damage and influence on the quality of patients life, because of the brain blood supply obstacles. Stroke is the third cause of death in western countries while the second place in our country, it’s about 10% death of the world. Because of the high mortality and morbidity of stroke, stroke prevention has become a very severe public problem. It is showed that statins can reduce coronary heart disease incidence significantly. However, as an important prevention and treatment measure of hypercholesterolemia, it is unclear that whether statins can prevent strokes. This article is to investigate statins for the strokes prevention, particularly for the incidence of fatal strokes and hemorrhagic strokes.Methods: The Pub Med, EMBASE and Central library databases were systematically retrieved for studies of statins for prevention of stroke in patients with high risks. No limited to country restriction and language, the retrieval time up to October 2012. Two experienced Meta-analysis researchers screened related literatures and accomplished the data extraction according to the strict inclusion and exclusion standards, evaluated the quality assessment according to the recommended Cochrane standards and the quality of evidence according to the Grade system independently. Using Review Manager(5.2 version 5.2.4; http://ims.cochrane.org/revman) software for the Meta-analysis. Main outcome measures were the incidence of overall stroke, the incidence of fatal and hemorrhagic stroke.Results: A total of 18 randomized controlled trial meet the inclusion criteria, involved eight countries, 74322 cases of patients. Among them, there are 12 studies provide fatal strokes data and 11 studies provide hemorrhagic strokes data, three studies included the patients who got a renal transplantation or undergoing hemodialysis, one study included patients with a history of TIA or stroke. Treatment group is statins(no limited to types and doses), the placebo group is regular treatment. Analysis shows that statins can significantly reduce the overall incidence of stroke(odds ratio [OR]: 0.80; 95% confidence interval [CI]: 0.74-0.87; P < 0.00001) compared with the placebo group. In addition, statins can reduce the risk of fatal stroke(OR: 0.90; 95% CI: 0.67-1.21; P = 0.47) and the incidence of hemorrhagic stroke(OR: 0.87; 95% CI: 0.60-1.25; P = 0.45). Rather, for the patients who got a renal transplant or undergoing hemodialysis group, statins may increase its incidence of overall stroke and fatal stroke(OR: 1.12; 95% CI: 0.89-1.41; P = 0.32)(OR: 1.37; 95% CI: 0.93-2.03; P = 0.11), but it can reduce the risk of hemorrhagic stroke(OR: 0.87; 95% CI: 0.53-1.42; P = 0.58). About statins for stroke secondary prevention, the hemorrhagic stroke risk increased according to a study using statins therapy, so statins may not be suitable for stroke secondary prevention.Conclusion: Statins can effectively reduce the incidence of overall stroke, it can also reduce the incidence of hemorrhagic stroke and fatal stroke. However, for the patients who got a kidney transplantation or undergoing hemodialysis or with a history of TIA and stroke, we should be careful using statins and carefully evaluate the requirements and dosage of statins for renal function protection of patients. Analysis should incorporated into more multi-center placebo controlled randomized trials which provide data hierarchy according to primary diseases and statin doses to further analyze the effect of statins for stroke prevention. |
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