Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2008 Sep;24(9):705-8.
doi: 10.1016/s0828-282x(08)70669-x.

Ischemic stroke: a cardiovascular risk equivalent? Lessons learned from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

David H Fitchett  1 , Shaun G Goodman, Anatoly Langer
Affiliations

Ischemic stroke: a cardiovascular risk equivalent? Lessons learned from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

David H Fitchett et al. Can J Cardiol. 2008 Sep.

Abstract
in English, French

Statin therapy in patients with coronary artery disease or in those at risk for cardiovascular disease is associated with a reduced incidence of ischemic stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed treatment with atorvastatin 80 mg daily in patients with a recent stroke or transient ischemic attack (TIA) reduces the incidence of fatal and nonfatal stroke by 16%. In this population with a recent stroke or TIA, coronary artery disease events and the need for revascularization were a frequent occurrence. Furthermore, the relative reduction of noncerebrovascular events and the need for revascularization was greater with atorvastatin than the reduction of stroke. A patient with a recent ischemic stroke or TIA is at high risk for fatal and nonfatal coronary events (approximately 4% per year), and according to most guidelines for the management of coronary artery disease, such patients should be in the high risk category. Consequently, ischemic stroke should be considered to be a coronary risk equivalent with a prognosis similar to that of a patient with coronary artery disease. Furthermore, both the stroke and coronary artery disease prognoses are improved by treatment with atorvastatin 80 mg daily.

Une thérapie aux statines chez les patients atteints d’une coronaropathie ou vulnérables à une maladie cardiovasculaire s’associe à une diminution de l’incidence d’accidents ischémiques cérébraux. L’essai SPARCL sur la prévention des accidents vasculaires cérébraux (AVC) par réduction énergique des taux de cholestérol a révélé qu’un traitement quotidien de 80 mg d’atorvastatine chez des patients qui avaient récemment subi un AVC ou un accident ischémique transitoire (AIT) réduit de 16 % l’incidence d’AVC fatal ou non fatal. Au sein de cette population ayant récemment subi un AVC ou un AIT, les événements reliés à la coronaropathie et la nécessité de revascularisation étaient courants. De plus, la réduction relative d’événements non vasculaires cérébraux et la nécessité de revascularisation étaient plus élevées avec l’atorvastatine que la réduction des AVC. Un patient ayant récemment subi un AVC ou un AIT court un risque élevé d’événement coronarien fatal ou non fatal (environ 4 % par année), et d’après la plupart des lignes directrices sur la prise en charge des coronaropathies, ces patients devraient faire partie de la catégorie à haut risque. Par conséquent, les accidents ischémiques cérébraux devraient être considérés comme un risque coronarien équivalent, au pronostic similaire à celui du patient atteint d’une coronaropathie. De plus, tant le pronostic d’AVC que celui de coronaropathie s’améliorent grâce à un traitement quotidien de 80 mg d’atorvastatine.

PubMed Disclaimer

Figures

Figure 1)
Figure 1)
Meta-analysis of studies comparing high-dose statin therapy with standard or low-dose therapy on the incidence of stroke in patients with coronary artery disease. A-to-Z Aggrastat to Zocor; IDEAL Incremental Decrease in Events through Aggressive Lipid Lowering; PROVE IT-TIMI 22 Pravastatin or Atorvastatin Evaluation and Infection Therapy –Thrombolysis in Myocardial Infarction 22; TNT Treating to New Targets. Reproduced with permission from reference
Figure 2)
Figure 2)
Kaplan-Meier curves for the first occurrence of fatal or nonfatal stroke and the effect of treatment with atorvastatin. Reproduced with permission from reference
Figure 3)
Figure 3)
Kaplan-Meier curves for the first occurrence of stroke or transient ischemic attack and the effect of treatment with atorvastatin. Reproduced with permission from reference
Figure 4)
Figure 4)
Kaplan-Meier curves for the first occurrence of any coronary event and the effect of treatment with atorvastatin. Reproduced with permission from reference
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Prospective studies collaboration. Lancet. 1995;346:1647–53. - PubMed
    1. Bots ML, Elwood PC, Nikitin Y, et al. Total and HDL cholesterol and risk of stroke. EUROSTROKE: A collaborative study among research centres in Europe. J Epidemiol Community Health. 2002;56(Suppl 1):i19–24. - PMC - PubMed
    1. Iso H, Jacobs DR, Jr, Wentworth D, Neaton JD, Cohen JD. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N Engl J Med. 1989;320:904–10. - PubMed
    1. Tirschwell DL, Smith NL, Heckbert SR, Lemaitre RN, Longstreth WT, Jr, Psaty BM. Association of cholesterol with stroke risk varies in stroke subtypes and patient subgroups. Neurology. 2004;63:1868–75. - PubMed
    1. Walldius G, Aastveit AH, Jungner I. Stroke mortality and the apoB/apoA-I ratio: Results of the AMORIS prospective study. J Intern Med. 2006;259:259–66. - PubMed

MeSH terms