Statin therapy reduces severity of second ischemic stroke in patients with no history of coronary heart disease

A secondary analysis of data from the Stroke Prevention with Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated that statin treatment can significantly reduce the severity of a second ischemic stroke in patients who had no history of coronary heart disease. With statin treatment, there were fewer fatal and severe strokes, fewer moderate and mild strokes, fewer transient ischemic attacks (TIAs), and more patients who had no events, said Larry B. Goldstein, MD, at the American Neurological Association (ANA) 131st Annual Meeting.

This analysis directly addressed the hypothesis that statin treatment can reduce stroke severity, said Dr Goldstein. Previous studies have had conflicting results, although experimental data have indicated that statins may have neuroprotective effects beyond their lipid-lowering ability. SPARCL was the first trial to demonstrate that statin treatment can significantly reduce the incidence of recurrent stroke.

The SPARCL trial included 4,731 patients (mean age, 63 years; mean baseline LDL cholesterol level, 133 mg/dL) who had experienced a stroke or a TIA during the previous 1 to 6 months but who had no history of coronary heart disease. Patients were randomized to receive atorvastatin 80 mg/d or placebo and were followed to determine whether aggressive lipid-lowering would reduce stroke reoccurrence.

There also was a significant reduction in major cardiovascular events among atorvastatin-treated patients (P=.003), for a 5-year absolute risk reduction of 3.5%. Overall mortality was similar between the 2 groups, and there was no difference in the incidence of serious adverse events. However, there was a small increase in the number of hemorrhagic strokes among treated patients (HR=1.66).

SEVERITY REDUCED

The secondary analysis included the 492 patients who had an ischemic stroke during the SPARCL trial follow-up. Stroke severity was measured with the National Institutes of Health stroke scale, Barthel index, and Rankin scale on initial enrollment in the SPARCL trial and again 90 days after the recurrent stroke during the trial.

Patients who had taken atorvastatin during the month preceding the recurrent stroke showed a significant decrease in stroke severity compared with those who had not (P=.007). According to Dr Goldstein, "The distribution shifted down. The number of fatal and severe strokes was reduced by about half, and there was an increase in the number of mild strokes." Among the recurrent strokes, 50.9% of mild strokes occurred in patients receiving atorvastatin during the previous month versus 42.8% of placebo patients. The rate of moderate strokes was 36.0% in the atorvastatin group versus 32.4% in the placebo group. The atorvastatin group demonstrated lower rates of severe strokes and fatal strokes (6.9% vs 11.3%, and 6.3% vs 13.5%, respectively) when compared with the placebo group. There was no significant difference in the stroke rates of patients who had received atorvastatin therapy after the initial stroke but had taken their last dose >1 month before the recurrent event.

These data from a randomized, controlled trial demonstrated a biologic effect of statins unrelated to lipid-lowering.According to Dr Goldstein, "If you are supposed to be taking a statin and are taking it, if you have another ischemic stroke, that stroke is going to be less severe."

SOURCE Goldstein LB. The SPARCL trial: effect of statins on stroke severity [abstract]. Presented at: American Neurological Association 131^st Annual Meeting; October 8–11, 2006; Chicago, Ill. Abstract T-60.