Statins Reduce Recurrent Stroke Risk

High doses of statins within six months of a stroke or transient ischemic attack (TIA) reduced the risk of recurrent stroke or TIA, according to the results of a new study.

Researchers from the Rosalind Franklin University of Medicine and Science (Chicago, IL, USA) conducted the double-blind Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial between September 1998 and March 2001. The study involved 4,731 patients who had baseline low-density lipoprotein (LDL) levels of 100 to 190 mg/dl and no known history of coronary heart disease. These were randomly assigned to either 80 mg of Lipitor (atorvastatin calcium), a statin drug, or to placebo. In both arms of the trial, the baseline mean LDL levels were about 133 mg/dl. All patients were enrolled within six months of a stroke or TIA. The average age of patients was 63, and 60% were men. Median duration of follow-up was 4.9 years.

Lipitor at 80 mg/day begun within six months of a stroke was associated with a 2.2% five-year absolute reduction in risk of stroke and a 16% relative reduction in risk of fatal or nonfatal stroke. Secondary endpoints, with the exception of death, also significantly favored the Lipitor group. These included stroke, TIA, major and minor coronary events and cardiovascular events, nonfatal heart attack, and revascularization. There were 216 deaths in the Lipitor arm and 211 in the placebo arm. The results were published in the August 10, 2006, issue of the New England Journal of Medicine.

The Lipitor benefit was driven by a reduction in "risk of cerebral infarction, the mechanism of which largely has been attributed to a reduction in LDL cholesterol levels,” wrote K. Michael Welch, M.B., Ch.B., and colleagues. The mean LDL in the Lipitor group was 73 mg/dl versus 129 mg/dl in the placebo group. However, Lipitor also increased the relative risk of hemorrhagic stroke by 66%; of the 88 patients who had at least one hemorrhagic stroke, 55 were in the Lipitor group.

Lipitor is the product of Pfizer (New York, NY, USA).



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Rosalind Franklin University of Medicine and Science
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