Pravastatin stroke

Tseng MY, Czosnyka M, Richards H, Pickard JD, Kirkpatrick PJ. Effects of acute treatment with pravastatin on cerebral vasospasm, autoregulation, and delayed ischemic deficits after aneurysmal subarachnoid hemorrhage a phase II randomized placebo-controlled trial. Stroke 2005 36 1627-1632. 

PROSPER Primary and secondary Pravastatin 2804, M 3000, F 70-82 4.0-9.0 3.2 CHD death, nfMI, stroke... 

TE, Moye LA, Piller LB, Rutherford J, Simpson LM, Braunwald 107. E. Reduction of stroke incidence after myocardial infarction with pravastatin the Cholesterol and Recurrent Events (CARE) study. 108. The Care Investigators. Circulation 1999 99 216-223. 

White H D et al 2000 Pravastatin therapy and the risk of stroke. New England Journal of Medicine 343 317-326... 

Byrington RP, Davis BR, Plehn JF, et al. Reduction of stroke events with pravastatin The Prospective Pravastatin Pooling (PPP) Project. Circulation 2001 103 387-392. 

Multiple well-controlled clinical trials have documented the efficacy and safety of simvastatin, pravastatin, lovastatin, and atorvastatin in reducing fatal and nonfatal CHD events, strokes, and total mortality. Rates of adverse events in statin trials were the same in the placebo groups and in the groups receiving the drug. This was true with regard to noncardiac illness and the two laboratory tests, hepatic transaminases and creatine kinase (CK), that are commonly monitored in patients taking statins. 

All HMGRIs are approved for the treatment of primary hypercholesterolemia and familial combined hyperlipidemia (Fredrickson s type Ha and lib) (Table 30.2) In patients who have not responded to diet, exercise, and other non pharmacological methods (Table 30.6) (15,21). They may be used either alone or In combination with bile acid sequestrants, ezetimibe, or niacin. As previously mentioned, they should be administered at least 1 hour before or 4 to 6 hours after bile acid sequestrants when this combination Is desired. Fluvastatin, lovastatin, pravastatin, and simvastatin have been specifically Indicated to reduce the mortality of CHD and stroke. By reducing plasma LDL levels, these compounds slow the progression of atherosclerosis and reduce the risk of myocardial Infarction and other ramifications of vascular occlusion. Atorvastatin, rosuvastatin, and simvastatin have been shown to be effective In homozygous familial hyperlipidemia and are Indicated for this use. Additionally, atorvastatin, pravastatin, and simvastatin are Indicated for primary dysbetallpoprotelnemla (Fredrickson s type III) (Table 30.2). Finally, atorvastatin, pravastatin, rosuvastatin, and simvastatin are Indicated for the treatment of hypertriglyceridemia. 

In 4162 patients hospitalized for an acute coronary syndrome, the median serum LDL-C level was 95 mg/dL in patients randomized to pravastatin 40 mg daily vs 62 mg/dL in patients randomized to atorvastatin 80 mg daily (86). At 2-year follow-up, the primary endpoint of death from any cause. Ml, documented unstable angina pectoris requiring rehospitalization, coronary revascularization (performed at least 30 days after randomization), and stroke was 26.3% in the pravastatin group vs 22.4% in the atorvastatin group, a 16% reduction in fevor of atorvastatin (p = 0.005) (86). 

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