title: Atorvastatin in stroke: a review of SPARCL and subgroup analysis.
abstract: Statin therapy in patients with cardiovascular disease is associated with reduced incidence of stroke. The Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial showed daily treatment with 80 mg of atorvastatin in patients with a recent stroke or transient ischemic attack (TIA) reduced the incidence of fatal or nonfatal stroke by 16%. Several post hoc analyses of different subgroups followed the SPARCL study. They have not revealed any significant differences when patients were sorted by age, sex, presence of carotid disease or type of stroke, with the exception of intracranial hemorrhage as the entry event. Lower low-density lipoprotein cholesterol levels in addition to possible neuroprotective mechanisms due to atorvastatin treatment correlate with improved risk reduction. Although not predefined subgroups and subject to an insufficient power, these post hoc studies have generated new clinical questions. However, clinicians should avoid denying therapy based on such subgroup analysis. At this point, the best evidence powerfully demonstrates stroke and TIA patients should be prescribed high dose statin therapy for secondary stroke prevention.
authors.affiliation: Department of Neuroscience, University of California, San Diego, CA 92103, USA. bhuisagarate@ucsd.edu
authors.forename: Branko N
authors.initials: BN
authors.lastname: Huisa
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Stemer
authors.forename: Justin A
authors.initials: JA
authors.lastname: Zivin
mesh_terms: D000367:Age Factors; D000368:Aged; D000069059:Atorvastatin; D002340:Carotid Artery Diseases / Q000150:complications; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D020300:Intracranial Hemorrhages / Q000139:chemically induced; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011758:Pyrroles / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin
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