An important study in this week’s New England Journal of Medicine expands what we know about the benefits of cholesterol lowering medications. Statins, a family of cholesterol lowering medications which include Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin), have already been proven to have many benefits. We already know that they prevent a first heart attack in patients who are at high risk of a heart attack because they have diabetes, or high cholesterol, or atherosclerosis (narrowing of the arteries). They also prevent a second heart attack in patients who have had a first heart attack, and prevent strokes in patients with coronary artery disease (narrowing of the arteries that supply blood to the heart itself).

The current study was designed to test if Lipitor helped prevent a second stroke in patients who had recently had a stroke. The study enrolled 4731 patients who had had a recent stroke or transient ischemic attack (a temporary stroke) and did not have known coronary artery disease. The patients were randomized to 80 mg daily of Lipitor or placebo and followed for about five years. In the group taking Lipitor 11.2% of the patients had another stroke, compared to 13.1% in the group taking placebo. That means that for every 45 patients taking Lipitor over 5 years, one stroke was prevented.

It’s safe to infer that almost all patients who have ever had a stroke or a heart attack or have atherosclerosis should be on a statin, even if their cholesterol by older standards would have been considered normal. The authors of the study conclude:

In conclusion, in patients with a recent stroke or TIA, treatment with 80 mg of atorvastatin per day decreased the risk of stroke… These results support the initiation of atorvastatin treatment soon after a stroke or TIA.