Crouse and colleagues1 report an impressive reduction in stroke incidence in the active treatment group of randomized controlled trials of reductase inhibitor monotherapy. This analysis, containing several large trials of therapies that led to substantial reductions in levels of circulating cholesterol, represents an advance on previous meta-analyses of cholesterol reduction and stroke risk.2,3 The first meta-analysis2 found an increase in stroke risk consequent on treatment, although it suffered from serious methodological weaknesses.4 The second meta-analysis3 found no effect of cholesterol reduction on stroke risk, although it was carried out before reports of the large reductase inhibitor trials.
Davey Smith G, Ebrahim S. Lowering of Cholesterol Levels and the Risk of Stroke. Arch Intern Med. 1998;158(1):98–99. doi: