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(Circulation. 2002;106:1595.)
© 2002 American Heart Association, Inc.

Editorial

Reducing the Risk for Stroke in Patients With Myocardial Infarction

A Myocardial Ischemia Reduction With Aggressive Cholesterol Lowering (MIRACL) Substudy

Antonio M. Gotto, Jr, MD, DPhil; John A. Farmer, MD

From Weill Medical College of Cornell University (A.M.G.), New York, NY, and Baylor College of Medicine (J.A.F.), Houston, Tex.

Correspondence to Antonio M. Gotto, Jr, MD, DPhil, c/o Paula Trushin, Weill Medical College of Cornell University, Olin Hall, Room 205, 445 E 69th St, New York, NY 10021. E-mail pat2004@med.cornell.edu

Key Words: Editorials • stroke • myocardial infarction • mortality • atherosclerosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Morbidity and mortality from cerebrovascular disease remain a major public health problem in the United States. Despite an encouraging decline in case fatality rates between 1989 and 1999, the actual number of stroke-related deaths increased during this period.¹ Approximately 600 000 people in the United States suffer an initial or recurrent stroke each year. Beyond the risk of death, the complications arising from cerebrovascular disease present a major personal and economic burden. Further therapies are needed both to reduce the incidence of initial stroke and to improve clinical outcomes after a cerebrovascular accident.

See p 1690

Lipids and Cerebrovascular Disease

Risk factors for the development of symptomatic cerebrovascular disease are multifactorial and at least partially related to age. They include the classical risk factors for coronary atherosclerosis.² The role of dyslipidemia as a risk factor for stroke, however, has been controversial.

The Prospective Studies Collaboration evaluated the association of both circulating cholesterol and diastolic blood pressure with the incidence of cerebrovascular disease.³ This meta-analysis of 45 prospective observational cohorts included 450 000 individuals who were followed over a 5- to 30-year period (mean duration of 16 years). Although stroke occurred in 13 397 participants, a definite statistical association between baseline cholesterol and stroke could not be determined after multivariate adjustment for sex, documented coronary atherosclerosis, ethnicity (Asian or non-Asian), and diastolic blood pressure. However, information on the pathogenesis of stroke was not available. This may compromise the statistical analysis because the lack of an overall correlation does not mean that there is no correlation . . . [Full Text of this Article]

Related Article:

Effects of Atorvastatin on Stroke in Patients With Unstable Angina or Non-Q-Wave Myocardial Infarction: A Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Substudy

David D. Waters, Gregory G. Schwartz, Anders G. Olsson, Andreas Zeiher, Michael F. Oliver, Peter Ganz, Michael Ezekowitz, Bernard R. Chaitman, Sally J. Leslie, Theresa Stern for the MIRACL Study Investigators
Circulation 2002 106: 1690-1695. [Abstract] [Full Text]