Are cholesterol-lowering medications and antihypertensive agents preventing stroke in ways other than by controlling the risk factor?

Statins and angiotensin-converting enzyme (ACE) inhibitors are an important component of our armamentarium for stroke prevention. Both of these classes of agents have a primary mechanism of action of reducing the level of the respective risk factor. They also have mechanisms of action that may confer benefits beyond what is believed to be the primary action of the agent. This has led to speculation that statins reduce stroke risk by means beyond cholesterol lowering, and ACE inhibitors reduce stroke risk by means beyond blood pressure lowering. We review the mounting evidence that suggests that statins and ACE inhibitors have so-called pleiotropic effects that may lead to stroke prevention.