Atherosclerosis plays the crucial role in pathogenesis of stroke, both ischemic and haemorrhagic. The majority of risk factors of coronary artery disease (hypertension, smoking, diabetes, obesity, age) are also the risk factors of stroke. Hypecholesterolaemia is a specific risk factor of atherosclerosis; however, the role of lipid disorders in the pathogenesis of stroke is still unclear. A positive correlation between level of cholesterol and stroke has been proved many times, but in some studies it has not been confirmed. Neither drugs decreasing cholesterol level such as cholestyramine, niacin, gemfibrosil, clofibrate nor low-cholesterol diet significantly influence stroke incidence.
Some studies with statins that have been conducted recently (4S, LIPID and CARE) in patients with coronary artery disease have revealed, that these drugs decrease the risk of stroke by 30%. There are many suggested mechanisms of this influence: slowing the progress of atherosc1erotic pathology in coronary arteries (coronary artery disease is the risk factor of stroke), influence on the cerebral arteries in a different mechanism than inhibition of cholesterol deposition (e.g. endothelial stabilisation, anti-inflammatory action). Studies with the use of statins were carried out in patients with coronary artery disease, who were younger than average stroke patient; therefore statins cannot be regarded as drugs with documented efficacy in stroke prevention. Statins should be prescribed in patients who have had a stroke episode only in cases of co-existing coronary artery disease.
There is a prospective study with the use of atorvastatin in secondary stroke prevention being carried out now.