Heart patients who receive intensive cholesterol-lowering therapy in the four months after myocardial infarction or other coronary event have about half the risk for stroke as patients not given drug treatment, according to an article in the September 3rd rapid access issue of Circulation.

Researchers analyzed data from the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial, which examined the effect of an early, rapid, and profound reduction in cholesterol on cardiovascular outcome after myocardial infarction or angina.

Between May 1997 and September 1999, 3,086 patients were randomly assigned to receive atorvastatin or placebo within four days of hospitalization. Currently, most U.S. patients start cholesterol-lowering therapy several weeks after an acute coronary event. Previous research had indicated other important treatments should be begun in the hospital and that dietary changes should be made before drugs are given, says David D. Waters, M.D., lead author of the study.

Stroke is a rare but devastating complication of an acute coronary event. In this four-month study, less that two percent of patients had a stroke. A total of 36 patients had 38 strokes -- 12 in statin-users, 24 in placebo-users. Three patients in the statin group and two in the placebo group had fatal strokes. There were three instances of hemorrhagic stroke, and all three were in the placebo group. Although statins have never been associated with increased risk for hemorrhagic stroke, there had been concern about a possible link because several studies found an increased risk of bleeding stroke in one group of men with naturally low cholesterol levels, Waters says.

"An estimated 1 million to 2 million people a year suffer from acute coronary syndromes each year in the United States alone. So if these results are confirmed in future studies, an absolute reduction of stroke of this order means that many strokes would be prevented," he says.

An accompanying editorial agrees that lowering cholesterol immediately after a myocardial infarction appears to reduce the risk for later stroke. However, the small number of patients who experienced a stroke in the current trial means that these results must be confirmed in larger studies, say editorial authors Antonio M. Gotto, Jr., M.D., D.Phil., and John A. Farmer, M.D.