Atorvastatin Reduces the Risk of Cardiovascular Events in Patients With Carotid Atherosclerosis : A Secondary Analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

• Published in: Stroke (1970) Vol. 39; no. 12; pp. 3297 - 3302
• Main Authors: SILLESEN, Henrik, AMARENCO, Pierre, HENNERICI, Michael G, CALLAHAN, Alfred, GOLDSTEIN, Larry B, ZIVIN, Justin, MESSIG, Michael, WELCH, K. Michael
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.12.2008
• Subjects: Aged; Atherosclerosis (general aspects, experimental research); Atorvastatin Calcium; Biological and medical sciences; Blood and lymphatic vessels; Brain Ischemia - complications; Brain Ischemia - mortality; Brain Ischemia - prevention & control; Cardiology. Vascular system; Carotid Stenosis - complications; Cerebral Hemorrhage - complications; Cerebral Hemorrhage - mortality; Cerebral Hemorrhage - prevention & control; Cholesterol, LDL - blood; Coronary Disease - complications; Coronary Disease - prevention & control; Female; Heptanoic Acids - therapeutic use; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hypercholesterolemia - complications; Hypercholesterolemia - drug therapy; Ischemic Attack, Transient - complications; Male; Medical sciences; Middle Aged; Neurology; Pyrroles - therapeutic use; Randomized Controlled Trials as Topic; Recurrence; Risk; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Carotid stenosis; Lipids; Cardiovascular disease; Hyperlipoproteinemia; Lipoprotein; Hypocholesterolemic agent; Arterial disease; Vascular disease; Prevention; HMG-CoA reductase inhibitor; Atherosclerosis; Dyslipemia; Cerebrovascular disease; Human; Stroke; Nervous system diseases; Enzyme; Enzyme inhibitor; Metabolic diseases; Statin derivative; Cholesterol; Cerebral disorder; Hypercholesterolemia; Carotid; Central nervous system disease; Atorvastatin; Hydroxymethylglutaryl-CoA reductase; Oxidoreductases; cholesterol-lowering drugs; Antilipemic agent
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.108.516450

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial found that treatment with atorvastatin 80 mg per day reduced the risk of stroke and cardiovascular events in patients with a recent transient ischemic attack (TIA) or stroke. We hypothesized this benefit would be greatest in the subgroup of patients with carotid stenosis. The SPARCL trial randomized patients with TIA or stroke within 1 to 6 months without known coronary heart disease (CHD) and low-density lipoprotein cholesterol 100 to 190 mg/dL to treatment with atorvastatin 80 mg per day or placebo. Investigators identified subjects as having carotid stenosis not requiring revascularization at the time of randomization. Of the total SPARCL population, 1007 were documented as having carotid stenosis at baseline, 3271 did not, and the status of 453 was unknown. We found no heterogeneity in the treatment effect for the SPARCL primary (fatal and nonfatal stroke) and secondary end points between the group with and without carotid stenosis. The group with carotid artery stenosis had greater benefit when all cerebro- and cardiovascular events were combined. In the group with carotid artery stenosis, treatment with atorvastatin was associated with a 33% reduction in the risk of any stroke (hazard ratio [HR] 0.67, 95% confidence interval [CI] 0.47, 0.94; P=0.02), and a 43% reduction in risk of major coronary events (HR 0.57, 95% CI 0.32, 1.00; P=0.05). Later carotid revascularization was reduced by 56% (HR 0.44, 95% CI 0.24, 0.79; P=0.006) in the group randomized to atorvastatin. Consistent with the overall results of the SPARCL intention to treat population, intense lipid lowering with atorvastatin reduced the risk of cerebro- and cardiovascular events in patients with and without carotid stenosis. The carotid stenosis group may have greater benefit.