REPLY
Coenzyme A Reductase Inhibitors and Stroke
Heiner C. Bucher, MD, MPH;
Lauren E. Griffith, MS; and
Gordon H. Guyatt, MD, MSc
15 July 1998 | Volume 129 Issue 2 | Page 162
IN RESPONSE:
Dr. Crouse wonders why we did not include seven additional trials of HMGcoA reductase inhibitors in our analysis. These trials did not report the number of strokes that occurred, so the requisite information for our analysis was not available. Dr. Crouse hypothesizes that the strong effect observed occurred because more of the HMGcoA studies are secondary prevention trials. Two meta-analyses analyzing the effects of HMGcoA inhibitors that have been published since our overview [1, 2] have found similar odds ratios with large, overlapping confidence intervals for the primary and secondary prevention trials involving HMGcoA reductase inhibitors. These data argue against Dr. Crouse's hypothesis. Dr. Crouse is correct that not all trials included in our analysis explicitly stated whether they excluded patients with previous strokes. However, it is highly unlikely that including such patients would affect the conclusions of our study.
Drs. Ornstein and Zacharski provide an interesting hypothesis about additional possible mechanisms for the beneficial effects of HMGcoA reductase inhibitors. We share their opinion that additional clinical studies are needed to confirm these mechanisms and to further elucidate their clinical relevance.
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Author and Article Information
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Medizinische Universitats-Poliklinik; CH-4031 Basel, Switzerland
McMaster University; Hamilton, Ontario L8N 3Z5, Canada
1. Hebert PR, Gaziano JM, Chan KS, Hennekens CH. Cholesterol lowering with statin drugs, risk of stroke, and total mortality. JAMA. 1997; 278:313-21.
2. Crouse JR III, Byington RP, Hoen HM, Furberg CD. Reductase inhibitor monotherapy and stroke prevention. Arch Intern Med. 1997; 157:1305-10.
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