***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Background — Prior primary prevention trials of statin therapy that used cholesterol criteria for enrollment have not reported significant decreases in stroke risk . We evaluated whether statin therapy might reduce stroke rates among individuals with low levels of cholesterol but elevated levels of high-sensitivity C-reactive protein . Methods and Results — In Justification for the Use of statins in Prevention : an Intervention Trial Evaluating Rosuvastatin ( JUPITER ) , 17 802 apparently healthy men and women with low-density lipoprotein cholesterol levels < 130 mg/dL and high-sensitivity C-reactive protein levels ≥2.0 mg/L were r and omly allocated to rosuvastatin 20 mg daily or placebo and then followed up for the occurrence of a first stroke . After a median follow-up of 1.9 years ( maximum , 5.0 years ) , rosuvastatin result ed in a 48 % reduction in the hazard of fatal and nonfatal stroke as compared with placebo ( incidence rate , 0.18 and 0.34 per 100 person-years of observation , respectively ; hazard ratio 0.52 ; 95 % confidence interval , 0.34 to 0.79 ; P=0.002 ) , a finding that was consistent across all examined subgroups . This finding was due to a 51 % reduction in the rate of ischemic stroke ( hazard ratio , 0.49 ; 95 % confidence interval , 0.30 to 0.81 ; P=0.004 ) , with no difference in the rates of hemorrhagic stroke between the active and placebo arms ( hazard ratio , 0.67 ; 95 % confidence interval , 0.24 to 1.88 ; P=0.44 ) . Conclusion — Rosuvastatin reduces by more than half the incidence of ischemic stroke among men and women with low levels of low-density lipoprotein cholesterol levels who are at risk because of elevated levels of high-sensitivity C-reactive protein . Clinical Trial Registration — clinical trial.gov . Unique identifier : NCT00239681 Background Patients with end-stage renal disease ( ESRD ) are at high risk of cardiovascular events . Multiple risk factors for atherosclerosis are present in ESRD and may contribute to the increased risk of cardiovascular mortality in this population . In contrast to patients with normal renal function , the benefits of modifying lipid levels on cardiovascular outcomes in patients with ESRD on haemodialysis have yet to be confirmed in large prospect i ve r and omised trials . A study to evaluate the Use of Rosuvastatin in subjects On Regular haemodialysis : an Assessment of survival and cardiovascular events ( AURORA ) will be the first large-scale international trial to assess the effects of statin therapy on cardiovascular morbidity and mortality in ESRD patients on chronic haemodialysis . Methods More than 2,750 ESRD patients who have been receiving chronic haemodialysis treatment for at least 3 months have been r and omised ( 1:1 ) , irrespective of baseline lipid levels , to treatment with  rosuvastatin 10 mg or placebo . The primary study endpoint is the time to a major cardiovascular event ( first occurrence of cardiovascular death , non-fatal myocardial infa rct ion or non-fatal stroke ) . Secondary endpoints include all-cause mortality , major cardiovascular event-free survival time , time to cardiovascular death , time to non-cardiovascular death , cardiovascular interventions , tolerability of treatment and health economic costs per life-year saved . Study medication will be given until 620 subjects have experienced a major cardiovascular event . Conclusion Our hypothesis is that results from AURORA will establish the clinical efficacy and tolerability of rosuvastatin in patients with ESRD receiving chronic haemodialysis and guide the optimal management of this exp and ing population BACKGROUND Clopidogrel is a more potent antiplatelet agent than aspirin , result ing in greater clinical efficacy in patients with atherothrombotic disease . Furthermore , the combination of clopidogrel plus aspirin has been demonstrated to be superior to aspirin alone in the treatment of patients with acute coronary syndromes and after coronary stenting . Whether dual antiplatelet therapy is superior to aspirin monotherapy for high-risk primary prevention and secondary prevention is unknown . METHODS AND RESULTS The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization , Management , and Avoidance ( CHARISMA ) study was design ed to evaluate the efficacy and safety of clopidogrel plus aspirin versus placebo plus aspirin in patients with established coronary , cerebral , or peripheral arterial disease or in patients with multiple risk factors for atherothrombosis who have not yet sustained an ischemic event . This r and omized , international , multicenter , double-blinded , placebo-controlled study has finished enrolling patients worldwide . A total of 15,603 patients will be followed long term . The primary end point will be the composite of vascular death , myocardial infa rct ion , or stroke . Rates of severe bleeding will also be compared between the two arms of the study . CONCLUSIONS This large-scale trial of patients at high risk for atherothrombotic events will allow determination of the value of a strategy of adding clopidogrel to the current st and ard of care , including low-dose aspirin , for a wide spectrum of patients with atherothrombosis Background and Purpose — Intracerebral hemorrhage ( ICH ) has a 30-day mortality rate of 40 % to 50 % and lacks a proven treatment . We report a preplanned , midpoint analysis of the first population -based , case-control study that examines both genetic and environmental risk factors of ICH . Methods — We prospect ively identified cases of hemorrhagic stroke at all 16 hospitals in the Greater Cincinnati/Northern Kentucky region . All cases underwent medical record and neuroimaging review . Cases enrolled in the direct interview and genetic sampling arm of the study were matched to population -based control subjects by age , race , and sex . Multivariable logistic regression was performed to identify significant independent risk factors . Results — We enrolled 188 cases of ICH ( 67 lobar , 121 nonlobar ) and 366 control subjects in the direct interview arm of the study . Significant independent risk factors for lobar ICH included the presence of an apolipoprotein E2 or E4 allele , frequent alcohol use , prior stroke , and first-degree relative with ICH . Significant independent risk factors for nonlobar ICH were hypertension , prior stroke , and first-degree relative with ICH . An increasing level of education was associated with a decreased risk of nonlobar ICH . The attributable risk of apolipoprotein E2 or E4 for lobar ICH was 29 % , and the attributable risk of hypertension for nonlobar ICH was 54 % . Conclusions — There is significant epidemiological evidence that the pathophysiology of ICH varies by location . We estimate that a third of all cases of lobar ICH are attributable to possession of an apolipoprotein E4 or E2 allele and that half of all cases of nonlobar ICH are attributable to hypertension BACKGROUND The role of lipid modification in stroke prevention is controversial , although increasing evidence suggests that HMG-CoA reductase inhibition may reduce cerebrovascular events in patients with prevalent coronary artery disease . METHODS AND RESULTS To test the hypothesis that cholesterol reduction with pravastatin may reduce stroke incidence after myocardial infa rct ion , we followed 4159 subjects with average total and LDL serum cholesterol levels ( mean , 209 and 139 mg/dL , respectively ) who had sustained an infa rct ion an average of 10 months before study entry and who were r and omized to pravastatin 40 mg/d or placebo in the Cholesterol and Recurrent Events ( CARE ) trial . Using prospect ively defined criteria , we assessed the incidence of stroke , a prespecified secondary end point , and transient ischemic attack ( TIA ) over a median 5-year follow-up period . Patients were well matched for stroke risk factors and the use of antiplatelet agents ( 85 % of subjects in each group ) . Compared with placebo , pravastatin lowered total serum cholesterol by 20 % , LDL cholesterol by 32 % , and triglycerides by 14 % and raised HDL cholesterol by 5 % over the course of the trial . A total of 128 strokes ( 52 on pravastatin , 76 on placebo ) and 216 strokes or TIAs ( 92 on pravastatin , 124 on placebo ) were observed , representing a 32 % reduction ( 95 % CI , 4 % to 52 % , P=0.03 ) in all-cause stroke and 27 % reduction in stroke or TIA ( 95 % CI , 4 % to 44 % , P=0.02 ) . All categories of strokes were reduced , and treatment effect was similar when adjusted for age , sex , history of hypertension , cigarette smoking , diabetes , left ventricular ejection fraction , and baseline total , HDL , and LDL cholesterol and triglyceride levels . There was no increase in hemorrhagic stroke in patients on pravastatin compared with placebo ( 2 versus 6 , respectively ) . CONCLUSIONS Pravastatin significantly reduced stroke and stroke or TIA incidence after myocardial infa rct ion in patients with average serum cholesterol levels despite the high concurrent use of antiplatelet therapy Background —This report describes the effect of intensive cholesterol lowering with atorvastatin on the incidence of nonfatal stroke , a secondary end point , in a r and omized ,  placebo-controlled  trial of patients with unstable angina or non-Q-wave myocardial infa rct ion . The primary end point , a composite of death , nonfatal myocardial infa rct ion , resuscitated cardiac arrest , or recurrent symptomatic myocardial ischemia with objective evidence requiring emergency rehospitalization , was reduced from 17.4 % in the placebo group to 14.8 % in the atorvastatin group over the 16 weeks of the trial ( P = 0.048 ) . Methods and Results —Strokes were adjudicated by a blinded end-point committee using st and ard clinical and imaging criteria . The outcomes of nonfatal stroke and fatal plus nonfatal stroke were analyzed by time to first occurrence during the 16-week trial . Of 38 events ( in 36 patients ) adjudicated as fatal or nonfatal strokes , 3 were classified as hemorrhagic , one as embolic , and 29 as thrombotic or embolic ; 5 could not be categorized . Nonfatal stroke occurred in 9 patients in the atorvastatin group and 22 in the placebo group ( relative risk , 0.40 ; 95 % confidence intervals , 0.19 to 0.88;P = 0.02 ) . Fatal or nonfatal stroke occurred in 12 atorvastatin patients and 24 placebo patients ( relative risk , 0.49 ; 95 % confidence intervals , 0.24 to 0.98;P = 0.04 ) . All 3 hemorrhagic strokes occurred in the placebo group . Conclusion —Intensive cholesterol lowering with atorvastatin over 16 weeks in patients with acute coronary syndromes reduced the overall stroke rate by half and did not cause hemorrhagic stroke . These findings need to be confirmed in future trials The FAST MI registry was design ed to evaluate the ' real world ' management of patients with acute myocardial infa rct ion ( MI ) , and to assess their in-hospital , medium- and long-term outcomes . Patients were recruited consecutively from intensive care units over a period of one month ( from October 2005 ) , with an additional one-month recruitment period for diabetic patients . The study included 3059 MI patients in phase 1 and an additional 611 diabetic patients in phase 2 . Altogether , 53 % of the patients had a final diagnosis of Q wave MI and 47 % had non Q wave MI . Patients with Q wave MI were more likely to be men , younger , more frequently with a family history or a history of smoking . Patients with non Q wave MI had worst baseline demographic and clinical characteristics mainly explained by their older age . Time from symptom onset to hospital admission was less than three hours for 22 % of the patients with Q wave MI and for 14 % of the non Q wave MI patients . Among patients with Q wave MI , 64 % received  reperfusion therapy  , 35 % with primary percutaneous coronary interventions , 19 % with pre-hospital thrombolysis and 10 % with in-hospital thrombolysis . Over 70 % of patients received  statin therapy during the hospital stay and over 90 % anti platelet agents .  In-hospital mortality was 5.8 % in patients with Q wave MI and 4.9 % in patients with non Q Wave MI . At discharge beta-adrenergic blockers and statins and , to a lesser extent , medications of the renin angiotensin system were commonly prescribed . Over 90 % received antiplatelet agents BACKGROUND Platelets play a key role in the pathogenesis of atherosclerosis , thrombosis , and acute coronary and cerebrovascular syndromes . Inhibition of platelet function by acetylsalicylic acid ( aspirin ) has been shown to reduce the incidence atherothrombotic 
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We found no evidence that statins were associated with intracerebral hemorrhage ; if such a risk is present , its absolute magnitude is likely to be small and outweighed by the other cardiovascular benefits of these drugs