SPARCL study的因果關係分析，statin降低major coronary event and stroke
lipitor 1 顆10mg, 吃到80mg 有點嚇人
NNT 是59 是有點不合
Cholesterol Reduction and the Brain–Heart Connection
A post hoc analysis of SPARCL data provides additional support for the benefits of statin therapy after a stroke or transient ischemic attack, in terms of both brain and cardiac protection.
Researchers previously reported a benefit from 80 mg of atorvastatin daily in preventing recurrent cerebrovascular and cardiovascular events over 5 years after a first stroke or transient ischemic attack (TIA) in the randomized, placebo-controlled, manufacturer-sponsored SPARCL trial (N Engl J Med 2006; 355:549; JW Cardiol Aug 30 2006). Now, the authors report subanalysis results. The 4731 participants had documented elevated LDL levels and stroke or TIA within the prior 6 months and no history or evidence of coronary heart disease (CHD). A handful of randomized patients were not included in the outcomes data for this report.
Rates of major coronary events (MCE) or any CHD endpoint were significantly lower with atorvastatin compared with placebo: Rates of MCE were 3.4% vs. 5.1%, respectively (absolute risk reduction, 1.7%; number needed to treat [NNT], 59). Rates of any CHD event were 5.2% and 8.6%, respectively (absolute risk reduction, 3.4%; NNT, 29). During the course of the study, stroke risk decreased with time but MCE risk remained stable. The rates of MCE and any CHD were similar between patients with and without carotid disease at baseline.
Comment: SPARCL is the only randomized, controlled clinical trial to date of high-dose statin therapy in patients with stroke or TIA and no evidence of CHD. This post hoc analysis of secondary endpoints provides additional support for the benefits of statin therapy for atherothrombotic stroke and TIA — now in terms of both brain and cardiac protection. Although these results would be expected given the natural history of the atherosclerotic process, finding that this benefit is independent of carotid artery disease is reassuring, because the most common cause of death after stroke is myocardial infarction. These data provide additional impetus for identifying elevated LDL levels in stroke and TIA patients and providing for long-term treatment per National Cholesterol Education Program III guidelines.
— Steven R. Levine, MD
Dr. Levine is Professor of Neurology, The Mount Sinai Stroke Center and The Mount Sinai School of Medicine, New York City. He serves on the primary prevention guidelines writing group for the American Heart Association/American Stroke Association with one of the authors of the current study.
Published in Journal Watch Neurology June 22, 2010
Citation(s):
Amarenco P et al. Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: Findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial. Stroke 2010 Mar; 41:426.
NNT 是59 是有點不合
Cholesterol Reduction and the Brain–Heart Connection
A post hoc analysis of SPARCL data provides additional support for the benefits of statin therapy after a stroke or transient ischemic attack, in terms of both brain and cardiac protection.
Researchers previously reported a benefit from 80 mg of atorvastatin daily in preventing recurrent cerebrovascular and cardiovascular events over 5 years after a first stroke or transient ischemic attack (TIA) in the randomized, placebo-controlled, manufacturer-sponsored SPARCL trial (N Engl J Med 2006; 355:549; JW Cardiol Aug 30 2006). Now, the authors report subanalysis results. The 4731 participants had documented elevated LDL levels and stroke or TIA within the prior 6 months and no history or evidence of coronary heart disease (CHD). A handful of randomized patients were not included in the outcomes data for this report.
Rates of major coronary events (MCE) or any CHD endpoint were significantly lower with atorvastatin compared with placebo: Rates of MCE were 3.4% vs. 5.1%, respectively (absolute risk reduction, 1.7%; number needed to treat [NNT], 59). Rates of any CHD event were 5.2% and 8.6%, respectively (absolute risk reduction, 3.4%; NNT, 29). During the course of the study, stroke risk decreased with time but MCE risk remained stable. The rates of MCE and any CHD were similar between patients with and without carotid disease at baseline.
Comment: SPARCL is the only randomized, controlled clinical trial to date of high-dose statin therapy in patients with stroke or TIA and no evidence of CHD. This post hoc analysis of secondary endpoints provides additional support for the benefits of statin therapy for atherothrombotic stroke and TIA — now in terms of both brain and cardiac protection. Although these results would be expected given the natural history of the atherosclerotic process, finding that this benefit is independent of carotid artery disease is reassuring, because the most common cause of death after stroke is myocardial infarction. These data provide additional impetus for identifying elevated LDL levels in stroke and TIA patients and providing for long-term treatment per National Cholesterol Education Program III guidelines.
— Steven R. Levine, MD
Dr. Levine is Professor of Neurology, The Mount Sinai Stroke Center and The Mount Sinai School of Medicine, New York City. He serves on the primary prevention guidelines writing group for the American Heart Association/American Stroke Association with one of the authors of the current study.
Published in Journal Watch Neurology June 22, 2010
Citation(s):
Amarenco P et al. Coronary heart disease risk in patients with stroke or transient ischemic attack and no known coronary heart disease: Findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial. Stroke 2010 Mar; 41:426.
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