High-dose atorvastatin after stroke or transient ischemic attack.

Details

Serval ID
serval:BIB_DD145D9DADAF
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
High-dose atorvastatin after stroke or transient ischemic attack.
Journal
The New England journal of medicine
Author(s)
Amarenco P., Bogousslavsky J., Callahan A., Goldstein L.B., Hennerici M., Rudolph A.E., Sillesen H., Simunovic L., Szarek M., Welch K.M., Zivin J.A.
Working group(s)
Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators
ISSN
1533-4406 (Electronic)
ISSN-L
0028-4793
Publication state
Published
Issued date
10/08/2006
Peer-reviewed
Oui
Volume
355
Number
6
Pages
549-559
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
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.
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.
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.
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].).

Keywords
Adult, Atorvastatin Calcium, Cardiovascular Diseases/prevention & control, Cerebral Hemorrhage, Cerebral Infarction/prevention & control, Cholesterol, LDL/blood, Drug Therapy, Combination, Female, Heptanoic Acids/adverse effects, Heptanoic Acids/therapeutic use, Humans, Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects, Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use, Ischemic Attack, Transient/drug therapy, Male, Proportional Hazards Models, Pyrroles/adverse effects, Pyrroles/therapeutic use, Risk, Secondary Prevention, Stroke/drug therapy, Stroke/mortality
Pubmed
Web of science
Create date
16/01/2018 13:51
Last modification date
20/08/2019 16:01
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