Take a Statin to Prevent a Second Stroke

In medicine, prevention is an activity that avoids the development of a disease or condition (primary prevention), prevents the recurrence of a disease (secondary prevention), or avoids a worsening of the condition (tertiary prevention). It’s now clear that it’s possible to prevent the recurrence of stroke in patients who had had a previous stroke or transient ischemic attack ( TIA ) by judicious use of a statin drug.

The clinical trial, called SPARCL (Stroke Prevention by Aggressive Reduction of Cholesterol Levels), included 4,700 stroke or TIA patients who were given either 80 mg daily of Lipitor® or placebo for about 5 years, starting within 6 months of their stroke. It was notable that they only had mildly raised cholesterol levels (normally an indication for the use of a statin).

Those patients on Lipitor had a 16% reduction in the risk of having another stroke, compared with those on placebo. And they had a 35% reduction in the risk of having a major coronary event (cardiac death, non-fatal heart attack, or surviving a cardiac arrest).

The average low-density lipoprotein (LDL) cholesterol level fell from 133 mg/dL at baseline to 73 mg/dL in those patients on Lipitor; over the 5-year period the LDL cholesterol was 7% lower in the Lipitor patients.

There was a very slight increase in the risk of hemorrhagic stroke in the Lipitor group of patients, but this risk was considered small compared with the benefits offered by the treatment. It looks as if the statins – and Lipitor (atorvastatin) in particular – will come to be used frequently in patients who have had a stroke. Note, however, that these results were obtained using the highest recommended dosage level of Lipitor. Never increase the dose of you medications without discussing this first with your doctor.