Statins for Neuroprotection After Acute Ischemic Stroke

See related article, p 3057 The pivotal SPARCL trial (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) randomized clinical trial demonstrated that atorvastatin 80 mg daily begun at 1 to 6 months after the index event in patients with noncardioembolic transient ischemic attack, and nonsevere ischemic stroke was effective and safe for the prevention of recurrent stroke and major cardiovascular events.1 But in addition to their benefits for vascular prevention, might statins also enhance neuroprotection or promote stroke recovery in the acute setting?Experimental studies in animal models have reported that 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) reduce infarct volumes and stroke severity.2 Potentially beneficial nonlipid lowering (pleiotropic) effects of statins include actions on the vascular wall (induction of angiogenesis, upregulation of endothelial nitric oxide synthase), improved cerebral blood flow, enhanced neural repair, antiplatelet, anti-inflammatory, and antioxidant effects.2,3 Observational studies and meta-analyses have reported that statin use either immediately before or shortly after stroke onset is associated with improved functional outcome and lower fatality at early follow-up.4 However, no matter how tempting, inferences about therapeutic efficacy cannot be made from observational studies because of …