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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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