title: Ischemic stroke: a cardiovascular risk equivalent? Lessons learned from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.
abstract: Statin therapy in patients with coronary artery disease or in those at risk for cardiovascular disease is associated with a reduced incidence of ischemic stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed treatment with atorvastatin 80 mg daily in patients with a recent stroke or transient ischemic attack (TIA) reduces the incidence of fatal and nonfatal stroke by 16%. In this population with a recent stroke or TIA, coronary artery disease events and the need for revascularization were a frequent occurrence. Furthermore, the relative reduction of noncerebrovascular events and the need for revascularization was greater with atorvastatin than the reduction of stroke. A patient with a recent ischemic stroke or TIA is at high risk for fatal and nonfatal coronary events (approximately 4% per year), and according to most guidelines for the management of coronary artery disease, such patients should be in the high risk category. Consequently, ischemic stroke should be considered to be a coronary risk equivalent with a prognosis similar to that of a patient with coronary artery disease. Furthermore, both the stroke and coronary artery disease prognoses are improved by treatment with atorvastatin 80 mg daily.
authors.affiliation: Canadian Heart Research Centre and St Michael's Hospital, Toronto, Canada.
authors.forename: David H
authors.initials: DH
authors.lastname: Fitchett
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
mesh_terms: D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002784:Cholesterol / Q000097:blood; D006538:Heptanoic Acids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control
chemical_list: D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D002784:Cholesterol; D000069059:Atorvastatin
references.citation: Circulation. 2002 Dec 17;106(25):3143-421
references.pmid: 12485966
references.citation: J Epidemiol Community Health. 2002 Feb;56 Suppl 1:i19-24
references.pmid: 11815640
references.citation: J Intern Med. 2006 Mar;259(3):259-66
references.pmid: 16476103
references.citation: J Am Coll Cardiol. 2006 Aug 1;48(3):438-45
references.pmid: 16875966
references.citation: Eur Heart J. 1998 Oct;19(10):1434-503
references.pmid: 9820987
references.citation: Lancet. 2004 Mar 6;363(9411):757-67
references.pmid: 15016485
references.citation: Circulation. 1999 Sep 28;100(13):1481-92
references.pmid: 10500053
references.citation: Circulation. 2002 Sep 24;106(13):1690-5
references.pmid: 12270864
references.citation: Neurology. 2004 Nov 23;63(10):1868-75
references.pmid: 15557504
references.citation: N Engl J Med. 1989 Apr 6;320(14):904-10
references.pmid: 2619783
references.citation: Can J Cardiol. 2006 Sep;22(11):913-27
references.pmid: 16971976
references.citation: Lancet. 1995 Dec 23-30;346(8991-8992):1647-53
references.pmid: 8551820
references.citation: J Am Coll Cardiol. 2005 Oct 18;46(8):1411-6
references.pmid: 16226163
references.citation: Stroke. 2005 Dec;36(12):2748-55
references.pmid: 16254218
references.citation: Circulation. 2003 Sep 9;108(10):1278-90
references.pmid: 12963684
references.citation: Stroke. 2004 Dec;35(12):2902-9
references.pmid: 15514180
references.citation: Stroke. 1989 Nov;20(11):1460-5
references.pmid: 2815179
references.citation: Stroke. 2007 Dec;38(12):3198-204
references.pmid: 17962589
references.citation: J Am Coll Cardiol. 2006 Nov 7;48(9):1793-9
references.pmid: 17084252
references.citation: N Engl J Med. 2006 Aug 10;355(6):549-59
references.pmid: 16899775
references.citation: Am J Cardiol. 2005 Sep 5;96(5A):39F-44F
references.pmid: 16126022