The use of statins in clinical neurology

HMG-CoA reductase inhibitors (statins) are potent cholesterol-lowering drugs and are established for the treatment of hypercholesterolemia. Furthermore, large clinical trials (4S, CARE, LIPID) demonstrated that statins are indicated for secondary prophylaxis of coronary heart disease (CHD) even in patients with average cholesterol levels. Although hypercholesterolemia is not an established risk factor for ischemic stroke, these studies demonstrated that statins also reduce stroke incidence in patients with CHD. The question whether or not statins are generally indicated for secondary prevention of stroke is subject of two ongoing trials (i.e. PROSPER, SPARCL). Clinical as well as experimental evidence supports the notion that statins exert cholesterol-independent (so-called,pleiotropic") protective effects. These include anti-inflammatory and anti-thrombotic effects, improvement of endothelial function and even direct neuroprotective effects. Furthermore, experimental and preliminary clinical studies suggest a potential role of statins for the treatment of dementia. Regarding the use of statins in clinical neurology, current evidence only supports the use for stroke prophylaxis in patients with a history of CHD.