Atorvastatin in the prevention of new strokes

A new analysis of the SPARCL trial has shown that in patients with recent stroke or transient ischemic attack (TIA), the total number of vascular events prevented with atorvastatin was more than twice the number of first events prevented.

The new analysis was published online in the Journal of the American College of Cardiology March 16, and will be released as part of the upcoming virtual American College of Cardiology 2020 Scientific Session/World Congress of Cardiology.

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial compared atorvastatin with placebo in 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease. Primary results of the trial, published in the New England Journal of Medicine in 2006, showed that atorvastatin reduced the first occurrence of stroke and the first occurrence of a composite of vascular events.

The current analysis assessed the occurrence of all (first and subsequent) vascular events and the effect of atorvastatin to reduce these events by vascular territory (cerebrovascular, coronary, or peripheral).

The total events reduction included 177 fewer cerebrovascular events, 170 fewer coronary events, and 43 fewer peripheral events. Over 6 years, an estimated 20 vascular events per 100 participants were avoided with atorvastatin treatment.

This new analysis also gives more information about the risk and benefits of statins in patients with previous hemorrhagic stroke.

Original results showed a small increase in risk of hemorrhagic stroke in the atorvastatin group, particularly in patients who had had a hemorrhagic stroke as their qualifying event.

The results of this new study on total events show that there is an increase in total stroke events in the patients with hemorrhagic stroke as the qualifying event in the atorvastatin group, but despite this, the total vascular events overall - including coronary and peripheral events - are reduced to a similar extent as in the whole population.