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Ischemic stroke: a cardiovascular risk equivalent? Lessons learned from the Stroke Prevention by Aggressive Reduction

David H Fitchett1, Shaun G Goodman, Anatoly Langer

  • 1Canadian Heart Research Centre and St Michael's Hospital, Toronto, Canada.

The Canadian Journal of Cardiology
|September 13, 2008
PubMed

Insights

Atorvastatin 80 mg daily significantly reduced stroke incidence by 16% in patients with recent stroke or TIA. This statin therapy also decreased noncerebrovascular events and revascularization needs, improving overall prognosis.

Area of Science:

  • Neurology
  • Cardiology
  • Pharmacology

Background:

  • Statin therapy reduces ischemic stroke in cardiovascular disease patients.
  • Patients with recent stroke or transient ischemic attack (TIA) are at high risk for recurrent cerebrovascular and coronary events.
  • Ischemic stroke is considered a coronary risk equivalent.

Purpose of the Study:

  • To evaluate the effect of atorvastatin 80 mg daily on stroke and non-stroke cardiovascular events in patients with a recent stroke or TIA.
  • To assess the impact of intensive statin therapy on the prognosis of patients with established atherosclerotic disease.

Main Methods:

  • The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.
  • Inclusion of patients with a recent stroke or TIA.
  • Treatment with atorvastatin 80 mg daily versus placebo.

Main Results:

  • Atorvastatin 80 mg daily reduced fatal and nonfatal stroke incidence by 16%.
  • Coronary artery disease events and revascularization needs were frequent in this population.
  • Atorvastatin demonstrated a greater relative reduction in noncerebrovascular events compared to stroke reduction.

Conclusions:

  • Atorvastatin 80 mg daily improves both stroke and coronary artery disease prognosis in patients with recent stroke or TIA.
  • Intensive statin therapy is beneficial for secondary prevention in patients with established atherosclerotic disease.
  • Patients with recent stroke or TIA represent a high-risk group warranting aggressive lipid-lowering treatment.

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