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High-Dose Atorvastatin Reduces the Overall Incidence of Stroke or Transient Ischemic Attack

August 11, 2006

By Sahar Bedrood B.S. and Asher Kimchi M.D.

North Chicago, IL - It has become evident that patients who take statins have a decreased incidence of stroke and cardiovascular risks. It has been, however, unknown whether patients with previous strokes or transient ischemic attacks (TIA) would benefit from taking statins. A study led by The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators showed that in patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events. This study was published in the August 10, 2006 issue of The New England Journal of Medicine.

The study randomly assigned 4731 patients who had a stroke or TIA within one to six months before study entry to double blind treatment with 80 mg of atorvastatin per day or placebo. The patients had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter, and had no known coronary heart disease. The primary end point was a first nonfatal or fatal stroke.

The mean LDL cholesterol level during the trial was 73 mg per deciliter among patients receiving atorvastatin and 129 mg per deciliter among patients receiving placebo. During median follow-up of 4.9 years, 265 patients receiving atorvastatin and 311 patients receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.8; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin.

The study concluded that in patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.

Co-authors: Pierre Amarenco, M.D. (Denis Diderot University, Paris), Julien Bogousslavsky, M.D. (University of Lausanne, Lausanne, Switzerland), Alfred Callahan, III, M.D. (Neurologic Consultants, Nashville), Larry B. Goldstein, M.D. (Duke University Medical Center, Durham, N.C.), Michael Hennerici, M.D., Ph.D. (Universitat Heidelberg, Mannheim, Germany), Amy E. Rudolph, Ph.D. (Pfizer, New York), Henrik Sillesen, M.D., D.M.Sc. (University of Copenhagen, Copenhagen), Lisa Simunovic, M.S. (Pfizer, New York), Michael Szarek, M.S. (Pfizer, New York), K.M.A. Welch, M.B., Ch.B., (Rosalind Franklin University of Medicine and Science, North Chicago), and Justin A. Zivin, M.D., Ph.D. (University of California, San Diego) assume full responsibility for the overall content and integrity of the article.

 


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