Findings from one of the largest medical studies in
history, published this month in the American Journal of
Cardiology, provide clear evidence that the
cholesterol-lowering medicine Zocor(R) (simvastatin) lowers
the risk of cerebrovascular events in people with coronary
heart disease by more than a quarter.
Entitled "Effect of Simvastatin on Ischemic Signs and
Symptoms in the Scandinavian Simvastatin Survival Study (4S)",
it is the first intervention trial to ever demonstrate a
direct link between cholesterol-reduction and stroke
prevention.
Stroke is Canada's third leading cause of death and the
leading cause of disability. It kills more than 15,000
Canadians each year, and represents approximately $2.5 billion
CDN in annual direct health expenditures. Ischemic strokes,
responsible for three quarters of all strokes, occur when a
blood clot blocks the flow of blood to the brain. Established
drugs used to help prevent stroke (most frequently
antiplatelet agents such as aspirin) seek to halt the
formation of blood clots and to prevent vascular
occlusions.
Although researchers have already proven
cholesterol-reduction with Zocor leads to significant
reduction in heart attack, it has only now been definitively
demonstrated that positive benefits can be achieved in stroke
prevention.
"Today's news is extremely important for Canadians at risk
for stroke," said Dr. Marc-André Lavoie, chief of internal
medicine, Montreal Heart Institute. "The stroke prevention
tool box physicians have traditionally turned to has been
limited. Antiplatelet agents are frequently accompanied by
side effects which limit their use.
"Reducing the risk of stroke by lowering cholesterol with
Zocor represents an extremely promising new treatment strategy
and one which is associated with very minor side effects."
The study included 4,444 men and women between 35 and 70
years of age. Each had coronary heart disease (history of
heart attack or angina) and moderately elevated cholesterol
levels. Patients received daily doses of either 20 mg or 40 mg
of Zocor.
As reported this month in the American Journal of
Cardiology, Zocor patients in the trial experienced:
-- 28 per cent risk reduction of cerebrovascular events
-- 28 per cent risk reduction of transient ischemic attacks
(TIA) or mini-strokes, considered warning signs of imminent
full-blown stroke
-- 48 per cent reduction in the development of carotid
bruit (a narrowing of the blood vessel in the neck)
"These results clearly indicate that Zocor has a valuable
role in preventing strokes and their horrific consequences,"
stated Dr. Jacques Genest Jr., director of the Cardiovascular
Genetics Laboratory at the Clinical Research Institute of
Montréal and Staff Cardiologist at the Centre hospitalier de
l'Université de Montréal.
Stroke accounts for seven per cent of all deaths in Canada.
According to recent Heart and Stroke Foundation statistics,
stroke accounted for 88 deaths per 100,000 people in Quebec in
1995.
Stroke is characterized as damage occurring in the brain
when blood flow is interrupted by either a blocked or burst
artery. This interruption deprives the brain of oxygen causing
brain cells to die. Hemorrhagic stroke, usually associated
with high blood pressure, occurs when blood vessels in the
brain rupture and damage surrounding tissue.
Symptoms of a stroke, such as weakness or paralysis on one
side of the body can develop abruptly or gradually.
Approximately one-third of major strokes are fatal, a third
result in some disability and a third have no lasting ill
effects. Risk factors for stroke include hypertension,
smoking, alcohol, diet and lack of exercise.
Zocor was approved in Canada in August, 1990. In May, 1996,
the product became the first and still is the only medication
in its class to receive special Health Canada designation as a
life-saving medicine.
Zocor is used in combination with diet to reduce
cholesterol levels in patients with primary
hypercholesterolemia when diet alone has not been
successful.
