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Atorvastatin After Stroke or TIA

Risk for recurrent stroke was lower with statin therapy.

In some randomized trials of statin therapy to prevent coronary events, lower rates of stroke were noted. However, no trial has been designed specifically to examine whether statins prevent strokes in patients with previous strokes. In this randomized, industry-sponsored trial, 4731 patients (with recent strokes or transient ischemic attacks, LDL cholesterol levels 100–190 mg/dL, and no known coronary disease) received daily atorvastatin (80 mg) or placebo. At baseline, mean LDL level was 133 mg/dL. Patients with severely disabling previous strokes were excluded.

During a median follow-up of 4.9 years, the incidence of fatal or nonfatal stroke was lower in the atorvastatin group than in the placebo group (11.2% vs. 13.1%). Unadjusted and adjusted analyses for 5-year risk reduction yielded P values of 0.05 and 0.03, respectively. Compared with placebo, atorvastatin was associated with significantly fewer ischemic strokes and significantly more hemorrhagic strokes; however, because about 85% of strokes were ischemic, the effect on ischemic strokes dominated the overall result. Risk for major adverse coronary events was significantly lower with atorvastatin than with placebo (3.4% vs. 5.1%), but overall mortality was similar (9.1% with atorvastatin and 8.9% with placebo). During the trial, LDL levels dropped by about 45% in the atorvastatin group but were unchanged in the placebo group.

Comment: In this trial, atorvastatin therapy reduced risk for stroke in patients with previous strokes or TIAs. Although the stroke result barely reached statistical significance, patients also benefited from a reduction in coronary events. Whether an 80-mg dose of atorvastatin is necessary to achieve secondary prevention of stroke is unclear.

— Allan S. Brett, MD

Published in Journal Watch General Medicine August 10, 2006

Citation(s):

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006 Aug 10; 355:549-59.

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