High-dose atorvastatin after stroke or transient ischemic attack
Pierre Amarenco1, Julien Bogousslavsky, Alfred Callahan
1Denis Diderot University, Paris.
Insights
Atorvastatin significantly reduced stroke incidence in patients with recent stroke or TIA. This statin therapy lowered cardiovascular event risk without increasing overall mortality.
Area of Science:
- Cardiology
- Neurology
- Pharmacology
Background:
- Statins are known to reduce cardiovascular disease risk.
- The efficacy of statins in preventing recurrent strokes after a recent stroke or transient ischemic attack (TIA) was previously unestablished.
Purpose of the Study:
- To investigate the effectiveness of atorvastatin in reducing stroke incidence in patients who recently experienced a stroke or TIA.
Main Methods:
- A double-blind, placebo-controlled trial involving 4731 patients with recent stroke/TIA and LDL cholesterol between 100-190 mg/dL.
- Patients received either 80 mg of atorvastatin daily or a placebo for a median follow-up of 4.9 years.
Main Results:
- Atorvastatin reduced the risk of fatal or nonfatal stroke by 11.2% compared to 13.1% in the placebo group (absolute risk reduction 2.2%).
- The incidence of major cardiovascular events was also reduced by 3.5% in the atorvastatin group.
- While ischemic strokes decreased, there was a slight increase in hemorrhagic strokes; however, overall mortality and serious adverse events were similar between groups.
Conclusions:
- Daily 80 mg atorvastatin effectively reduces the overall incidence of strokes and cardiovascular events in patients with recent stroke or TIA.
- The benefits of atorvastatin in this patient population outweigh the risks, including a small increase in hemorrhagic stroke incidence.
Background:
Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established.
Methods:
We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke.
Results:
The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin.
Conclusions:
In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:27Coronary Artery Disease V: Interprofessional Care
01:26Atherosclerosis III: Management
01:23Atherosclerosis IV: Nursing Management
01:15Ischemic Stroke l: Introduction
01:26Transient Ischemic Attack l: Introduction