Hemorrhagic stroke occurs when a weakened blood vessel ruptures in the head, allowing blood to flow outside it’s normal channel and likewise causing death or disruption of neurons. Most hemorrhagic stroke occurs in people with high blood pressure.

The large majority of strokes are ischemic strokes, and high cholesterol contributes to the risk for those strokes. This is why statins are used for both primary and secondary prevention – i.e. to prevent a first stroke and a follow-on stroke.

The medicines have a less of a preventative effect in patients without diagnosed artery disease. Further, even after people have had a stroke or transitory ischemic attack, using statins reduces the risk of a second stroke. This may be due to statins' biochemical action that aid in brain recovery after a stroke.

Epidemiological studies have shown that statins help elderly people as well as younger stroke patients in recovery. Two European studies show statins reduce the risk of venous thromboembolism. It is also worth distinguishing between ischemic stroke and hemorrhagic stroke. Ischemia is when the brain's blood supply is cut off by thrombosis or embolism, while hemorrages are when tissue ruptures to release blood. Statins decrease the risk of ischemic stroke, but there is some indication that they increase the risk of hemorrhagic stroke.

A meta-analysis found that a reduction in serum cholesterol level of only 18 mg/dl reduces the chance of stroke by 20%. The risk of non-fatal stroke fell more than the risk of fatal stroke.

Given that the etiology of heart disease and strokes are similar, it is not surprising that statins would be beneficial for strokes, although it should be noted that epidemiological and observational studies have not shown a definitive association between cholesterol levels and stroke. Researchers suspect that statins play a part beyond their cholesterol-lowering function in stroke prevention. This may be one of the pleiotropic effects of statins.

Recent research provides further evidence that high-intensity statin therapy could be beneficial for those at risk for strokes. Both primary and secondary prevention of ischemic stroke may be aided by statins.

About one in eight strokes is a Hemorrhagic Stroke (as opposed to a ischemic stroke) in which blood seeps from weakened vessels in the brain. There is a chance that statin usage slightly increases the risk of hemorrhagic stroke in patients who have had a previous stroke.

Peripheral Arterial Disease

This disease is caused by cholesterol plaques on the blood vessels in parts of the body outside and chest, neck, and head. The classic example is disease in the legs.

It’s basically atherosclerosis in the rest of the body. Like other atherosclerosis it is caused by high cholesterol levels in the bloodstream, and statins can reduce risk. Such amorphous descriptions of disease as "poor circulation", "vascular disease", and "claudication" often turn out to be peripheral arterial disease (PAD). Other names include peripheral vascular disease and atherosclerotic peripheral arterial disease. The patient often notices leg cramps or weakness, especially during exercise. Sometimes sores that won’t easily heal are a sign, and some people get shiny skin near affected areas.

Why is peripheral arterial disease bad? Blocked or narrowed blood vessels can result in pain and weakness in the affected parts of the body. If bad enough and left untreated, gangrene can set in.

Peripheral arterial disease also increases risk for heart attack, coronary heart disease, and stroke. The 1-year mortality rate for these patients might be as high as 20 percent. When a patient has PAD he or she is always given a close examination of the entire cardiovascular system. PAD patients with high LDL-C are often put on a statin medication. If the LDL-C level is low, niacin and/or fibrates are employed.

The goals of the treatment of PAD are to

• reduce pain,
• slow the progression of atherosclerosis,
• improve the macro- and microcirculation,
• reduce the risk of blood clots that will break off and cause cardiovascular and cerebrovascular events

After coronary heart disease and cerebrovascular disease, PAD of the legs is the biggest target of atherosclerotic disease. And studies have shown major benefits from statin therapy for these patients.

The news is mixed on whether statins improve treadmill times in patients with claudication in the legs, but they have been shown to help with symptoms and with endothelial function.

Venous Thrombus and Pulmonary Embolism

Blood clots can form in the body due to many factors. If a clot travels in the blood it is called a thromboembolism and it if gets to the pulmonary arteries that supply blood to the lungs, the result is a pulmonary embolism. Pulmonary embolisms are dangerous and about one in three times results in death.