Friday, June 09, 2006

Statins for secondary stroke prevention

Last week, while the Interventional cardiologist were meeting in Paris, France, the neurologist were meeting in Brussels, Belgium, for the 15th meeting of the European Stroke conference. Dr M Welch of Chicago, presented the "Stroke prevention by aggressive cholesterol lowering" (SPARCL) study.

Dr Welch and colleagues studied 4731 patients with a history of stroke or TIA, but who had no known heart disease, and fairly normal cholesterol levels (the average LDL cholesterol was 133mg/dL). The study compared patients given placebo with ptients given Atorvastatin 80 mg daily. After 4.4 years followup, there was a reduction is ischemic strokes and TIAs and also fatal and non-fatal strokes. There was also the obvious LDL cholesterol reduction. Perhaps the only spoiler (pardon my use of the word) was the slightly increase incidence of hemorrhagic strokes.

It is important to note that this is the first study on Statins and strokes. We know that in all previous study of statins (eg HPS, 4S, LIPDS), they were in a population with or without heart disease, and we were measuring cardiac and CVS endpoints. In SPARCL, the authors studied a population with no known heart disease but with cerebrovascular disease. Statins, the wonder drug, what else will we use it for next?

Statins for the seconadry prevention of strokes. Perhaps before long, we will be postulating that stroke too is an inflammatory disease?

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