Atorvastatin in stroke: a review of SPARCL and subgroup analysis.
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.
Huisa
Branko N
BN
Department of Neuroscience, University of California, San Diego, CA 92103, USA. bhuisagarate@ucsd.edu
Stemer
Andrew B
AB
Zivin
Justin A
JA
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
D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin
Stroke. 2008 Sep;39(9):2444-8
18617654
Atherosclerosis. 2009 Jun;204(2):515-20
18962621
Am J Cardiol. 2005 Sep 5;96(5A):24F-33F
16126020
Stroke. 2007 Dec;38(12):3198-204
17962589
Stroke. 2009 Jul;40(7):2581-4
19407227
Lancet. 2005 Oct 8;366(9493):1267-78
16214597
Cochrane Database Syst Rev. 2003;(2):CD000029
12804384
Lancet. 1994 Nov 19;344(8934):1383-9
7968073
BMJ. 2006 Jul 1;333(7557):22
16757495
Stroke. 2000 Oct;31(10):2442-9
11022078
Circulation. 1999 Jan 19;99(2):216-23
9892586
Neurology. 2009 Feb 24;72(8):688-94
18768917
Neurology. 2008 Jun 10;70(24 Pt 2):2364-70
18077795
Eur J Neurol. 2005 Jul;12(7):493-8
15958087
JAMA. 2004 Apr 21;291(15):1864-70
15100205
JAMA. 1995 May 10;273(18):1421-8
7723155
Stroke. 2008 Dec;39(12):3297-302
18845807
N Engl J Med. 1998 Nov 5;339(19):1349-57
9841303
Ann Intern Med. 1998 Nov 1;129(9):681-9
9841599
Stroke. 2010 Mar;41(3):426-30
20110538
Eur Heart J. 2008 Jul;29(13):1605-7
18523057
J Neurochem. 2005 Mar;92(6):1386-98
15748157
JAMA. 2002 Jul 24-31;288(4):455-61
12132975
Ann Neurol. 2003 Jun;53(6):743-51
12783420
Neurology. 2005 Jul 26;65(2):253-8
16043795
Stroke. 2009 Apr;40(4):1405-9
19228842
Stroke. 2004 Dec;35(12):2902-9
15514180
Stroke. 1989 Nov;20(11):1460-5
2815179
Stroke. 2008 Jun;39(6):1779-85
18369173
Lancet. 2002 Jul 6;360(9326):7-22
12114036
Lancet. 2002 Nov 23;360(9346):1623-30
12457784
Arterioscler Thromb Vasc Biol. 2007 Nov;27(11):2470-5
17717296
Stroke. 2009 Oct;40(10):3384-9
19644071
J Neurotrauma. 2007 Jul;24(7):1132-46
17610353
JAMA. 2005 Sep 14;294(10):1255-9
16160134
Lancet. 2003 Apr 5;361(9364):1149-58
12686036
Lancet. 2005 Nov 19;366(9499):1773-83
16298214
Brain Res. 2009 Dec 15;1303:144-50
19781532
Stroke. 2003 Jan;34(1):157-63
12511768
N Engl J Med. 1989 Apr 6;320(14):904-10
2619783
Lancet. 2004 May 8;363(9420):1491-502
15135594
Can J Cardiol. 2008 Sep;24(9):705-8
18787721
Stroke. 2009 Nov;40(11):3526-31
19745172
Stroke. 2008 Jul;39(7):2151-4
18436876
Stroke. 2005 Jun;36(6):1298-300
15879346
Stroke. 1999 Dec;30(12):2535-40
10582974
Stroke. 2009 Jul;40(7):2486-92
19461031