High-dose Atorvastatin After Stroke or Transient Ischemic Attack

Amarenco, Pierre; Bogousslavsky, Julien; Callahan, Alston

doi:10.1016/j.jvs.2006.10.008

Cited by 380 publications

(514 citation statements)

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“…140 In the randomized SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, atorvastatin (80 mg daily) reduced the absolute risk of stroke at 5 years by 2.2%, the RR of all stroke by 16%, and the RR of ischemic stroke by 22% among patients with recent stroke or TIA. 13 In the Heart Protection Study, there was a 50% reduction in CEA in patients randomized to statin therapy. 141 It is less clear whether lipidmodifying therapies other than high-dose statins reduce the risk of ischemic stroke or the severity of carotid artery disease.…”

Section: Risk Factor Managementmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott

Halperin

Abbara

et al. 2011

Cathet Cardio Intervent

184

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Section: Risk Factor Managementmentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Brott

Halperin

Abbara

et al. 2011

Cathet Cardio Intervent

184

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“…Despite the association of low cholesterol levels [122,123] and the use of a statin with ICH [124], there is a growing interest in the pleiotropic effects of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (i.e., statins). The promising neuroprotective benefit of the statins in acute ischemic stroke [125][126][127] has led to a similar evaluation in ICH models.…”

Section: Anti-inflammatory Agents: Statinsmentioning

confidence: 99%

Treatment Targets in Intracerebral Hemorrhage

Sangha

Gonzales

2011

Neurotherapeutics

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Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease.

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“…It seems that cholesterol has the opposite relationship to ischemic stroke (positive relation) and hemorrhagic stroke (inverse relation) [40]. Yet, lipid lowering using 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors ("statins") in clinical trials have reduced overall stroke risk in both at-risk populations and after ischemic stroke [41][42][43]. Metaregression analysis of data from more than 160,000 participants in 24 randomized trials showed that statin treatment decreases 21% of the nonfatal first ischemic stroke per 1.0 mmol/L (39 mg/dL) reduction in LDL cholesterol.…”

Section: Dyslipidemiamentioning

confidence: 99%

“…In patients with a history of non-cardioembolic stroke or TIA without known CHD, the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed that atorvastatin (80 mg) compared with a placebo lowers overall stroke recurrence by 16%, regardless of the ischemic stroke subtype at entry [42,47]. The absolute risk reduction during a 5-year time span was 2.2%, with a number needed to treat of 45 during the 5 years.…”

Section: Dyslipidemiamentioning

confidence: 99%

Treatment of Risk Factors to Prevent Stroke

Aoki

Uchino

2011

Neurotherapeutics

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Much of the decline in stroke incidence and mortality for the past several decades in Western countries has been attributed to better treatment of risk factors. Many epidemiological studies and clinical trials confirmed the importance of managing hypertension. Comparative trials of anti-hypertensive drugs or drug classes have not yielded clear results, but blood pressure variability may play an important role beyond the absolute value of blood pressure. Diabetes therapy remains a conundrum. Although diabetes is clearly a risk factor for ischemic stroke, treatment trials targeting different glycemic goals have not indicated that glucose lowering results in stroke prevention. Trials focused on insulin resistance are ongoing and they may be able to help establish the management of diabetes/impaired glucose tolerance. Evidence for treatment of dyslipidemia has contrasted science to diabetes mellitus. Dyslipidemia has not been strongly or consistently linked to ischemic stroke but the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed the impact of statin treatment in stroke prevention. The results of clinical trials investigating dabigatran and rivaroxaban clearly indicate alternative strategies to vitamin K antagonists in stroke prevention for persons with atrial fibrillation. Evidence for stroke prevention by life style modification, treating metabolic syndrome, sleep disordered breathing, lipoprotein (a), hyperhomocysteinemia, and coagulation disorders are also discussed.

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High-dose Atorvastatin After Stroke or Transient Ischemic Attack

Cited by 380 publications

References 0 publications

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Executive summary

Treatment Targets in Intracerebral Hemorrhage

Treatment of Risk Factors to Prevent Stroke

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