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Research Highlight | 30 November 2017

Preventing stroke in Asian populations

A common cholesterol drug could help prevent certain types of strokes in Asian people

Asian stroke patients could reduce their risk of another occurrence of one type by stroke by taking a low dose of statins, a common cholesterol drug, according to Japanese researchers.

East Asians stroke profiles differ from Caucasians in that they experience cerebral small blood vessel diseases more frequently. This can include blockages of the small vessels that deliver blood to the brain or intracerebral haemorrhages, which occur when one of the blood vessels bursts and leaks blood into the brain.

“We can’t extrapolate the Caucasian evidence on clinical trials for statin therapies directory to clinical practice for Asian populations,” explains Masayasu Matsumoto of Hoshigaoka Medical Center. Instead, he says, any findings from Caucasian studies need to be retested for an Asian population.

To address this gap, Matsumoto and colleagues, in collaboration with the Translational Research Informatics Center, set-up the Japan Statin Treatment Against Recurrent Stroke study, or ‘J-STARS’ for short. The study followed 1,578 patients who attended one of 123 medical centres between March 2004 and February 2009. The study participants were aged between 45 and 80 years. After randomization around half were given a daily dose of ten milligrams of pravastatin — a statin typically used to lower cholesterol production, reduce cardiovascular disease and help prevent initial strokes. A lower than usual dose was given to minimize risk, due to the higher chance of cerebral haemorrhage in Japanese. The other half of the study participants were not given medication, although some later took statins as part of normal medical treatment. The patients were followed up for a period of five years.

Both groups later reported many categories of strokes and ‘mini-strokes’ — transient ischaemic attack — in equal measure. However the researchers found that the onset of atherothrombotic brain infarction — one of the most common types of stroke — was significantly less frequent for the pravastatin group. Matsumoto believes the cholesterol-lowering drug may have prevented the subjects’ arteries from hardening and clogging.

“It was quite surprising for us that low-dose pravastatin treatment quite effectively reduced the occurrence of stroke due to larger artery atherosclerosis,” says Matsumoto.

Millions of people are affected by stroke annually, and the incidence of stroke in Asian populations — particularly in East Asian countries such as Japan, China, Taiwan, Mongolia, South and North Korea — is higher than that of coronary events such as heart attacks. This is particularly marked in countries like Japan with an advanced ageing population.

Accordingly, says Matsumoto, “the establishment of prevention strategies for stroke epidemic is essential.”


  1. Hosomi, N. et al. The Japan Statin Treatment Against Recurrent Stroke (J-STARS): A multicenter, randomized, open-label, parallel-group study. EBioMedicine 2, 1071–1078 (2015). | article

About the Researcher

Masayasu Matsumoto, Adviser, Sakai City Medical Center, Sakai City, Osaka, Japan

Dr Masayasu Matsumoto is a professor emeritus of Hiroshima University, has been working as a director of Hoshigaoka Medical Center since 2015 and as an adviser of Sakai City Medical Center since April 2018. He is an active member of the World Stroke Organization’s board of directors. In 1976, he graduated from Osaka University and after training in clinical neurology, carried out several clinical and basic research studies on Stroke Neurology at Osaka University, the Mayo Clinic and Hiroshima University. He was also involved in several stroke registry and intervention studies such as REACH, JSSRS, HARP, CSPS, PROGRESS, JAST, J-ROCKET AF, J-PPP and J-STARS.

Sakai City Medical Center

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