In people who have experienced a stroke, but who have no known history of coronary heart disease, beginning regular treatment with the cholesterol-lowering drug atorvastatin soon after the stroke can reduce the risk of recurrent stroke by 16 percent, according to a five-year study led by an international team that includes a researcher at Duke University Medical Center.
The results of the study, called the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, appear in the August 10, 2006, issue of the New England Journal of Medicine. The study was funded by Pfizer, the manufacturer of atorvastatin.
"This is the first study to demonstrate that treatment with a statin, a type of cholesterol-lowering drug, can reduce the risk of strokes in patients who have had a recent stroke or a transient ischemic attack and who have no known history of coronary heart disease," said Larry B. Goldstein, M.D., director of the Duke Stroke Center and a member of the SPARCL steering committee.
A transient ischemic attack is similar to a stroke, but is of shorter duration and severity. Often referred to as a ministroke, it is considered a warning sign or prelude for stroke.
"These results will have a major effect on how people are treated following a stroke," Goldstein said. "The findings are very important for physicians and patients because they show that the addition of this drug to other treatments further reduces the risk of another stroke, which is a pretty big step in improving what we can do for stroke patients."
Previous studies, Goldstein said, have demonstrated that atorvastatin and other drugs within the class of medications called statins could reduce risk of stroke in patients who have a history of coronary disease. Coronary heart disease is a narrowing of the small blood vessels that supply blood to the heart, usually due to a build-up of cholesterol. It is a leading cause of death for Americans, he added.
The study results showed that atorvastatin -- sold as Lipitor -- in addition to reducing recurrent stroke risk, can also reduce stroke patients' risk of heart attack and other major coronary events by 35 percent; their risk of cardiovascular events such as unstable angina by 42 percent; and their need for coronary revascularization procedures, such as coronary artery bypass grafting or cardiac catheterization, by 45 percent, compared to treatment with an inactive placebo.
In the trial, the researchers enrolled 4,731 patients at 205 study sites in Africa, Australia, Europe, the Middle East, and North and South America. All of the patients had experienced either a stroke or a transient ischemic attack within six months of their enrollment. The patients averaged 63 years of age; 60 percent were male and 40 percent female. Patients were monitored for an average of five years following enrollment.
At the time of their enrollment, roughly 66 percent of the patients had experienced an ischemic stroke, which occurs when the blood supply to a part of the brain is suddenly blocked; 2 percent had experienced a hemorrhagic stroke, which occurs due to a leaking blood vessel in the brain; and 30 percent had experienced a transient ischemic attack.