(Circulation. 1999;99:185-188.)
© 1999 American Heart Association, Inc.
Editorials |
Natural Statins and Stroke Risk
From the Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC.
Correspondence to Dr Curt D. Furberg, Professor and Chairman, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063. E-mail cfurberg@wfubmc.edu
Key Words: Editorials • statins • stroke
The Burden of Stroke
In the United States, 
600 000 persons experience a
clinical stroke (first or recurrent) annually.1 Although
the case-fatality rate has declined over the past decades, it is still
high. The annual death toll is 150 000, which qualifies stroke as
the third leading cause of death, behind coronary heart disease
(CHD) and cancer. The clinical sequelae of a stroke are often
devastating. Among the more than 3 million stroke survivors,
approximately one half have hemiparesis, one third are clinically
depressed, one quarter cannot walk, and one sixth are
aphasic.2 Stroke is the leading cause of serious
disability in the United States.1 Thus, evidence of
promising preventive therapies that can reduce the human and societal
costs of stroke is welcome news.
The burden of stroke goes well beyond those cases that are
clinically recognized. New imaging techniques of the brain have
revealed a remarkably high prevalence of so-called infarct-like lesions
(ILLs), or silent strokes. The NHLBI-sponsored
Cardiovascular Health Study obtained cerebral MRIs on
3658 men and women 
65 years old. ILLs 3 mm were found in 31%
of all subjects.3 Fewer than 15% of those with such
lesions had a clinical history of stroke. The prevalence of ILLs
increased with age; 22% of subjects 65 to 69 years old had ILLs,
compared with 43% in subjects 80 years old. Subjects with ILLs were
more likely to be hypertensive or to have a history of stroke, atrial
fibrillation, or dilated cardiomyopathy.
Importantly, the presence of these lesions was associated with a
decline
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