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Drug Insight: translating evidence on statin therapy into clinical benefits

Abstract

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed that, in patients who had experienced a stroke or transient ischemic attack, treatment with high-dose atorvastatin over a 5-year period significantly reduced the risk of a subsequent stroke. SPARCL also showed that the benefits of an intensive statin regimen in these patients extended beyond reduction of secondary stroke to include significant reductions in future major vascular events. SPARCL has established statin treatment as a key component of a multimodal vascular risk reduction strategy after an ischemic stroke or transient ischemic attack. It is recommended that the vast majority of patients with ischemic cerebrovascular events should be started on statin therapy, preferably before discharge from acute hospitalization for their index event, with the goal of achieving and maintaining consensus guideline cholesterol targets as soon and for as long as possible.

Key Points

  • Statins are therapeutic agents with proven atheroprotective benefits that are thought to be mediated primarily through the lowering of serum LDL cholesterol concentration

  • The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed that daily high-dose statin treatment reduces the incidence of future stroke and cardiovascular events in patients with recent stroke or transient ischemic attack

  • In the SPARCL study, treatment with atorvastatin was associated with a relative increase in intracerebral hemorrhage, but the net vascular benefit from statin treatment far outweighs this risk

  • The benefits of statin initiation in the immediate aftermath of an acute ischemic stroke remain unclear, although discontinuation of these drugs in this setting seems to be associated with poor outcome

  • The American Stroke Association recommends that a statin should be initiated during hospitalization for first ischemic stroke of atherosclerotic origin

  • Statins should form part of a multimodal approach to vascular risk reduction after stroke, which should also include antithrombotics, normoglycemics when indicated, and antihypertensives

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Correspondence to Nerses Sanossian.

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Competing interests

N Sanossian has received honoraria from Astra-Zeneca. B Ovbiagele declared no competing interests.

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Sanossian, N., Ovbiagele, B. Drug Insight: translating evidence on statin therapy into clinical benefits. Nat Rev Neurol 4, 43–49 (2008). https://doi.org/10.1038/ncpneuro0705

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