Atorvastatin Improves Carotid Stenosis Outcomes


BOSTON — Atorvastatin significantly reduced the risk of stroke, cardiac events, and carotid endarterectomy in a large group of patients with carotid stenosis, Dr. Henrik Sillesen reported at the annual meeting of the American Academy of Neurology.

Over 5 years, the drug cut the incidence of stroke and heart attacks by more than 30%, and halved the incidence of endarterectomy in these high-risk patients, he said in an interview.

“Patients with carotid stenosis should certainly have aggressive treatment with atorvastatin at 80 mg per day,” said Dr. Sillesen, chairman of vascular surgery at Rigshospitalet, Copenhagen.

He presented the results of a subanalysis of the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, which focused on risk reduction in a subgroup of patients with existing coronary stenosis.

The Pfizer-supported SPARCL trial randomized 4,731 patients who had experienced an ischemic stroke, hemorrhagic stroke, or transient ischemic attack 1-6 months prior to either atorvastatin (Lipitor) 80 mg/day or placebo. After an average of 4.9 years of follow-up, stroke had occurred in 265 subjects in the atorvastatin group, compared with 311 in the placebo group, a 2.2% absolute difference. The drug also decreased the 5-year risk of other major cardiovascular events, with a 3.5% absolute difference and a 20% relative reduction in risk.

There was no difference between groups in overall mortality.

Patients in SPARCL were allowed to take other cardiovascular medications, including open-label statins, aspirin or other antiplatelet drugs, ACE inhibitors, dihydropyridine derivatives, β-blockers, angiotensin receptor antagonists, or vitamin K antagonists.

The subanalysis reported by Dr. Sillesen included 1,006 patients with a history of carotid stenosis. Compared with those taking placebo, patients taking the drug had a 34% reduction in the occurrence of stroke and a 36% reduction in major cardiovascular events (cardiac death, stroke, resuscitated cardiac arrest, and fatal and nonfatal myocardial infarction). Revascularization procedures were reduced by 50%, which included a 54% decrease in the number of carotid endarterectomies.

Atorvastatin stabilizes arterial plaque formation, thus preventing atherosclerotic disease progression, even in this subgroup of patients with more advanced disease, noted Dr. Sillesen, who has reported that he's received grant support from Pfizer and consulting and lecture fees from several other pharmaceutical companies.


Recommended Reading

Intracerebral Hemorrhage Guideline Update Issued
MDedge Cardiology
Promise of rFVIIa Dimmed In Hemorrhagic Stroke Trial
MDedge Cardiology
Intracranial Atherosclerosis Tied to Fatal Ischemic Stroke
MDedge Cardiology
Carotid Stenting May Lessen Ocular Ischemia, Restore Sight
MDedge Cardiology
Poststroke VTE Risk Cut by 43% With Enoxaparin vs. Unfractionated Heparin
MDedge Cardiology