Journal Article10.1056/NEJMOA061894
High-dose atorvastatin after stroke or transient ischemic attack.
Pierre Amarenco,Julien Bogousslavsky,Callahan A rd,Larry B. Goldstein,M.G. Hennerici,Amy E. Rudolph,Henrik Sillesen,Lisa Simunovic,Michael Szarek,K M Welch,Justin A. Zivin,Stroke Prevention by Aggressive Reduction in Cholesterol Levels (Sparcl) Investigators +11 more
2.6K
TL;DR: In this paper, the authors showed that 80 mg of atorvastatin per day reduced the overall incidence of stroke and cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.
read more
Abstract: Background Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established. Methods We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke. Results The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin. Conclusions In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).
read more
Chat with Paper
AI Agents for this Paper
Find similar papers on Google Scholar, PubMed and Arxiv
Write a critical review of this paper
Analyze citations of this paper to find unaddressed research gaps
Citations
Transient Ischemic Attack.
TL;DR: Key Clinical Points Transient Ischemic Attack Cerebral or retinal symptoms consistent with transient ischemic attack usually last for seconds or minutes and typically last less than 1 hour.
65
Intensive Treat-to-Target Statin Therapy in High-Risk Japanese Patients With Hypercholesterolemia and Diabetic Retinopathy: Report of a Randomized Study
Hiroshi Itoh,Issei Komuro,Masahiro Takeuchi,Takashi Akasaka,Hiroyuki Daida,Yoshiki Egashira,Hideo Fujita,Jitsuo Higaki,Ken-ichi Hirata,Shun Ishibashi,Takaaki Isshiki,Sadayoshi Ito,Atsunori Kashiwagi,Satoshi Kato,Kazuo Kitagawa,Masafumi Kitakaze,Takanari Kitazono,Masahiko Kurabayashi,Katsumi Miyauchi,Tomoaki Murakami,Toyoaki Murohara,Koichi Node,Susumu Ogawa,Yoshihiko Saito,Yoshihiko Seino,Takashi Shigeeda,Shunya Shindo,Masahiro Sugawara,Seigo Sugiyama,Yasuo Terauchi,Hiroyuki Tsutsui,Kenji Ueshima,Kazunori Utsunomiya,Masakazu Yamagishi,Tsutomu Yamazaki,Shoei Yo,Koutaro Yokote,Kiyoshi Yoshida,Michihiro Yoshimura,Nagahisa Yoshimura,Kazuwa Nakao,Ryozo Nagai +41 more
TL;DR: No significant decrease in CV events or CV-associated deaths with intensive therapy is found, possibly because the between-group difference of LDL-C was lower than expected (27.7 mg/dL at 36 months of treatment).
Cortical superficial siderosis predicts early recurrent lobar hemorrhage
Duangnapa Roongpiboonsopit,Andreas Charidimou,Christopher William,Arne Lauer,Guido J. Falcone,Sergi Martinez-Ramirez,Alessandro Biffi,Alison M. Ayres,Anastasia Vashkevich,Oluwole Awosika,Jonathan Rosand,M. Edip Gurol,Scott B. Silverman,Steven M. Greenberg,Anand Viswanathan +14 more
TL;DR: Dseminated cSS on MRI and cSAH on CT are independent imaging markers of increased risk for early recurrent ICH, and may provide additional insights into the mechanisms of ICH recurrence in patients with cerebral amyloid angiopathy.
65
Multi-omics approaches for revealing the complexity of cardiovascular disease.
Stephen Doran,Muhammad Arif,Simon Lam,Abdulahad Bayraktar,Hasan Turkez,Mathias Uhlén,Jan Borén,Adil Mardinoglu,Adil Mardinoglu +8 more
TL;DR: In this paper, a wide array of systems biology approaches incorporating multi-omics data have emerged as an invaluable tool in establishing alterations in specific cell types and identifying modifications in signalling events that promote disease development.
Statins and Risk of Intracerebral Hemorrhage in Individuals With a History of Stroke
Anette Riisgaard Ribe,Claus Høstrup Vestergaard,Mogens Vestergaard,Henrik Schou Pedersen,Anders Prior,Lone Winther Lietzen,Peter Krogh Brynningsen,Morten Fenger-Grøn +7 more
TL;DR: This large study found no evidence that statins increase the risk of intracerebral hemorrhage in individuals with prior stroke; perhaps the risk is even lower in the subgroup of Individuals with prior ischemic stroke.
65
References
Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels
Andrew Tonkin,P. Alyward,David Colquhoun,Paul Glasziou,P. Harris,D. Hunt,Anthony C Keech,Stephen MacMahon,P. Magnus,D. Newel,P. Nestel,N. Sharpe,J. Shaw,R. J. Simes,P. Thompson,Alexis A. Thompson,Malcolm J. West,H. White,S. Simes,Wendy Hague,Sue Caleo,Jane Hall,Andrew J. Martin,S. Mulray,Philip J. Barter,Lawrence J. Beilin,Rory Collins,John J McNeil,Petra Meier,H. Willimott,D. Smithers,P. Wallace,J. Baker,M. Hobbs,David R. Sullivan,N. Anderson,Graeme J. Hankey,John D.G. Watson,M. Arulchelvam,S. Chup,John Daly,J. Hanna,A. Leach,M. Lee,J. Loughhead,H. Lundie-Jenkin,J. Morrison,S. Netting,A. Nguyen,H. Pater,R. Philip,G. Pinna,D. Rattos,S. Ryerson,V. Sazhin,Richard Walsh,A. Claque,M. Mackie,Julie Jane Yallop,K. Boss,M. Shepard,J. Leach,M. Gandy,J. Joughin,J. Seabrook,R. Abraham,J. Allen,F. Bates,I. Beinart,E. Breed,D. Brown,N. Bunyan,D. Calvert,T. Campbell,D. Condon-Paoloni,B. Conway,Lucy A. Coupland,J. Crowe,N. Cunio,B. Cuthbert,N. Cuthbert,S. D'Arcy,Patricia M. Davidson,B. Dwyer,J. England,C. Friend,Greg Fulcher,S. Grant,K. Hellestrand,M. Kava,Leonard Kritharides,D. McGill,H. McKee,Allan J. McLean,M. Neaverson,G. Nelson,M. O'Neill,C. Onuma,F. O'Reilly +98 more
TL;DR: Pravastatin therapy reduced mortality from coronary heart disease and overall mortality, as compared with the rates in the placebo group, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.
5.5K
Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial
Helen M. Colhoun,D. John Betteridge,Paul N. Durrington,Graham A. Hitman,H. Andrew W. Neil,Shona Livingstone,Margaret J Thomason,Michael I. Mackness,Valentine Charlton-Menys,John H. Fuller +9 more
TL;DR: Atorvastatin 10 mg daily is safe and efficacious in reducing the risk of first cardiovascular disease events, including stroke, in patients with type 2 diabetes without high LDL-cholesterol.
3.9K
Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial
Peter S. Sever,Björn Dahlöf,Neil R Poulter,Hans Wedel,Gareth Beevers,Mark J. Caulfield,Rory Collins,Sverre E. Kjeldsen,Arni Kristinsson,Gordon T. McInnes,Jesper Mehlsen,Markku S. Nieminen,Eoin O'Brien,Jan Östergren +13 more
TL;DR: The reductions in major cardiovascular events with atorvastatin are large, given the short follow-up time, and may have implications for future lipid-lowering guidelines.
3.7K
Cerebral vascular accidents in patients over the age of 60. II. Prognosis.
TL;DR: A survey was carried out on a number of 'untreated' cases seen shortly after the onset of a cerebral vascular accident, with particular reference to the presence of signs which had prognostic value, to enable the investigator to assess the results of specific forms of treatment.
2.5K
Related Papers (5)
Walter N. Kernan,Bruce Ovbiagele,Henry R. Black,Dawn M. Bravata,Marc I. Chimowitz,Michael D. Ezekowitz,Margaret C. Fang,Marc Fisher,Karen L. Furie,Donald V. Heck,S. Claiborne Johnston,Scott E. Kasner,Steven J. Kittner,Pamela H. Mitchell,Michael W. Rich,DeJuran Richardson,Lee H. Schwamm,John A. Wilson +17 more
Andrew Tonkin,P. Alyward,David Colquhoun,Paul Glasziou,P. Harris,D. Hunt,Anthony C Keech,Stephen MacMahon,P. Magnus,D. Newel,P. Nestel,N. Sharpe,J. Shaw,R. J. Simes,P. Thompson,Alexis A. Thompson,Malcolm J. West,H. White,S. Simes,Wendy Hague,Sue Caleo,Jane Hall,Andrew J. Martin,S. Mulray,Philip J. Barter,Lawrence J. Beilin,Rory Collins,John J McNeil,Petra Meier,H. Willimott,D. Smithers,P. Wallace,J. Baker,M. Hobbs,David R. Sullivan,N. Anderson,Graeme J. Hankey,John D.G. Watson,M. Arulchelvam,S. Chup,John Daly,J. Hanna,A. Leach,M. Lee,J. Loughhead,H. Lundie-Jenkin,J. Morrison,S. Netting,A. Nguyen,H. Pater,R. Philip,G. Pinna,D. Rattos,S. Ryerson,V. Sazhin,Richard Walsh,A. Claque,M. Mackie,Julie Jane Yallop,K. Boss,M. Shepard,J. Leach,M. Gandy,J. Joughin,J. Seabrook,R. Abraham,J. Allen,F. Bates,I. Beinart,E. Breed,D. Brown,N. Bunyan,D. Calvert,T. Campbell,D. Condon-Paoloni,B. Conway,Lucy A. Coupland,J. Crowe,N. Cunio,B. Cuthbert,N. Cuthbert,S. D'Arcy,Patricia M. Davidson,B. Dwyer,J. England,C. Friend,Greg Fulcher,S. Grant,K. Hellestrand,M. Kava,Leonard Kritharides,D. McGill,H. McKee,Allan J. McLean,M. Neaverson,G. Nelson,M. O'Neill,C. Onuma,F. O'Reilly +98 more