Statins and the stroke-cholesterol paradox

Although strokes belong to the group of cardiovascular disorders, there is no clear association between LDL and/or HDL levels and 'stroke' as an entity. However, there is ample evidence that statins reduce stroke risk in selected patient groups such as survivors of myocardial infarction. This apparent paradox can be explained on the one hand by the heterogeneity of strokes as a group and on the other hand by the specific characteristics of statins. There are strong indications for a relationship between blood lipid profiles and types of stroke that have atherosclerosis as the underlying pathogenetic mechanism. Apart from their ability to reduce LDL levels significantly, statins have a number of other properties, which influence the process of atherosclerosis at various stages. Future and ongoing trials have to prove which patients at risk for stroke will benefit most from the preventive use of statins.