Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial

Introduction

Study characteristics:

• randomized, industry-sponsored trial
• 4731 patients with recent strokes or TIA
  • patients with prior severely disabling strokes excluded
• LDL cholesterol levels 100-190 mg/dL
  • mean baseline LDL cholesterol level 133 mg/dL
• no known coronary disease

Groups:

• atorvastatin 80 mg PO QD
• placebo. At baseline, mean LDL level was 133 mg/dL.

median follow-up of 4.9 years

Results:

• incidence of stroke was lower in atorvastatin group than in placebo group (11.2% vs. 13.1%)*
  • atorvastatin associated with fewer ischemic strokes & more hemorrhagic strokes
  • 85% of strokes were ischemic, thus overall strokes lower in atorvastatin group
• risk for major adverse coronary events lower in atorvastatin group (3.4% vs. 5.1%)
• mortality was similar (9.1% atorvastatin, 8.9% placebo)
• LDL cholesterol levels dropped by about 45% in atorvastatin group but were unchanged in placebo group

* stroke result barely reached statistical significance

More general terms

• ischemic stroke prevention trial

Additional terms

• atorvastatin (Lipitor)
• ischemic stroke