Historically, the etiological link between
hypercholesterolemia and
stroke has been less clear than for
coronary heart disease. The lack of association between
cholesterol levels and
stroke in most epidemiological and observational studies has brought about this controversy. Many recent, long-term clinical studies have confirmed that
statin therapy results in a reduced risk of
strokes, even in so-called "normocholesterolemic" patients. The magnitude of the effect is great. A large-scale analysis of more than 90,000 individuals showed that every 10% reduction in the concentration of
LDL-cholesterol reduces the risk of
stroke by 15.6%. The positive effect of
statins on
stroke depends mainly on
LDL cholesterol reduction, but other non-
lipid mechanisms, so-called "pleiotropic" effects, have been shown to play a role. This review seeks to summarize the role of
statins in
stroke prevention. Despite the fact that our understanding of the benefits of
statins in
stroke prevention is still evolving, we find marked room for improvement in
stroke risk factor management. Internists must face this challenge and integrate this new knowledge into their daily clinical practice.