In patients who have suffered a recent stroke or transient ischemic attack, the statin atorvastin reduces the risk of further strokes and cardiovascular events, finds the SPARCL study, presented in the clinical trial update session I by Prof. Amarenco.
Background
The impact of statins on stroke risk after recent stroke or TIA remains to be established.
Methods
Patients (n=4731) with recent stroke or TIA within 1-6 months without CHD received atorvastatin 80 mg/day or placebo (mean LDL-C 73 mg/dL, atorvastatin and 129 mg/dL, placebo). The primary end point was fatal or nonfatal stroke. On-treatment analysis was based on 55,045 LDL-C measurements. Percent change in LDL-C from baseline was classified as no change from baseline, <50% reduction or ≥50% reduction. 88% of atorvastatin patients had at least one measurement corresponding to a ≥50% reduction.
Results
A primary endpoint occurred in 265 patients (11.2%) receiving atorvastatin and 311 patients (13.1%) receiving placebo (adjusted HR=0.84; 95% CI 0.71-0.99, P=0.03). 218 ischemic and 55 hemorrhagic strokes occurred with atorvastatin and 274 ischemic and 33 hemorrhagic strokes with placebo. The absolute 5-year risk reduction in major cardiovascular events was 3.5% (HR=0.80; 95% CI 0.69-0.92, P=0.002). Compared to no change or increase in LDL-C, stroke risk was reduced by 31% in patients with ≥50% LDL-C reduction (HR 0.69, 95% CI, 0.55-0.87, P=0.0016), including 33% reduction in ischemic stroke risk (HR 0.67, 95% CI, 0.52-0.86, P=0.0018), but no effect on the risk of hemorrhagic stroke (HR 1.04 (95% CI, 0.61-1.78, P= 0.8864).
Conclusion
In patients with recent stroke or TIA without CHD, atorvastatin 80 mg reduced the risk of stroke and cardiovascular events. Patients most adherent to atorvastatin 80 mg experienced the lowest risk of ischemic stroke with no increased risk of hemorrhagic stroke
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