title: Relative effects of statin therapy on stroke and cardiovascular events in men and women: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study.
abstract: OBJECTIVE
  In SPARCL, treatment with atorvastatin 80 mg daily reduced stroke risk in patients with recent stroke or TIA and no known coronary heart disease by 16% versus placebo over 4.9 years of follow-up. The purpose of this secondary analysis was to determine whether men and women similarly benefited from randomization to statin treatment.
  
  
  METHODS
  The effect of sex on treatment-related reductions in stroke and other cardiovascular outcomes were analyzed with Cox regression modeling testing for sex by treatment interactions.
  
  
  RESULTS
  Women (n=1908) constituted 40% of the SPARCL study population. At baseline, men (n=2823) were younger (62.0+/-0.21 versus 63.9+/-0.27 years), had lower systolic BPs (138.1+/-0.35 versus 139.5+/-0.47 mm Hg), higher diastolic BPs (82.2+/-0.20 versus 81.0+/-0.25 mm Hg), more frequently had a history of smoking (73% versus 38%), and had lower total cholesterol (207.0+/-0.54 versus 218.9+/-0.67 mg/dL) and LDL-C levels (132+/-0.45 versus 134+/-0.57 mg/dL) than women. Use of antithrombotics and antihypertensives were similar. After prespecified adjustment for region, entry event, time since event, and age, there were no sex by treatment interactions for the combined risk of nonfatal and fatal stroke (treatment Hazard Ratio, HR=0.84, 95% CI 0.68, 1.02 in men versus HR=0.84, 95% CI 0.63, 1.11 in women; treatment x sex interaction P=0.99), major cardiac events (HR=0.61, 95% CI 0.42, 0.87 in men versus HR=0.76, 95% CI 0.48, 1.21 in women; P=0.45), major cardiovascular events (HR=0.78, 95% CI 0.65, 0.93 in men versus HR=0.84, 95% CI 0.65, 1.07 in women; P=0.63), revascularization procedures (HR=0.50, 95% CI 0.37, 0.67 in men versus HR=0.76, 95% CI 0.46, 1.24 in women; P=0.17), or any CHD event (HR=0.54, 95% CI 0.41, 0.72 in men versus 0.67 95% CI 0.46, 0.98 in women; P=0.40).
  
  
  CONCLUSIONS
  Stroke and other cardiovascular events are similarly reduced with atorvastatin 80 mg/d in men and women with recent stroke or TIA.
authors.affiliation: Duke University Medical Center, Durham, NC 27710, USA. golds004@mc.duke.edu
authors.forename: Larry B
authors.initials: LB
authors.lastname: Goldstein
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Marian
authors.initials: M
authors.lastname: Lamonte
authors.forename: Steven
authors.initials: S
authors.lastname: Gilbert
authors.forename: Michael
authors.initials: M
authors.lastname: Messig
authors.forename: Alfred
authors.initials: A
authors.lastname: Callahan
authors.forename: Michael
authors.initials: M
authors.lastname: Hennerici
authors.forename: Henrik
authors.initials: H
authors.lastname: Sillesen
authors.forename: K Michael A
authors.initials: KM
authors.lastname: Welch
mesh_terms: D016632:Apolipoprotein A-I / Q000097:blood; D000069059:Atorvastatin; D001794:Blood Pressure / Q000502:physiology; D002784:Cholesterol / Q000097:blood*; D003627:Data Interpretation, Statistical; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006973:Hypertension / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000008:administration & dosage*; D015203:Reproducibility of Results; D012727:Sex Characteristics; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
chemical_list: D016632:Apolipoprotein A-I; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D014280:Triglycerides; D002784:Cholesterol; D000069059:Atorvastatin