Should Statin Agents Be Administered to All Patients With Ischemic Stroke?

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Abstract
Statin agents have revolutionized the management of atherosclerotic vascular disease.1,2 They have surpassed other classes of pharmacologic agents in the reduction of the incidence of myocardial infarction, stroke, and total mortality and, therefore, have been referred to as “miracle drugs.”2 Not only do these drugs competitively inhibit 3-hydroxy-3-methyglutaryl coenzyme A, the last regulated reaction in the synthesis of cholesterol, but also they have non–lipid-lowering (pleiotropic) actions.2 For example, statins may upgrade endothelial nitric oxide synthase, inhibit inducible nitric oxide synthase, attenuate the inflammatory cytokine responses associated with cerebral ischemia, possess anti-oxidant properties, and modify endothelial function, plaque vulnerability, and thrombus formation. Because statin agents may reduce levels of C-reactive protein independent of low-density lipoprotein cholesterol lowering, it has been suggested that statins have important anti-inflammatory effects in addition to lipid-lowering effects.3