Review of the SPARCL trial and its subanalyses

Abstract

The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study is a prospective, randomized, placebo-controlled trial that was designed to determine whether 80 mg/d of atorvastatin reduced the risk of fatal or nonfatal stroke in patients who had previously experienced a stroke or transient ischemic attack. It is unique in that it is the only trial to study this cohort of patients with no known coronary heart disease. The review recaps the results of the primary SPARCL data and discusses the findings of subsequent analyses that extend the conclusions from the study. Atorvastatin reduced the risk of stroke to a clinically persuasive degree. This benefit was present despite a small increase in risk of intracerebral hemorrhage. Factors were identified in SPARCL that might reduce this risk if implemented. Further subanalyses addressed other questions relative to stroke profile of benefit and potential mechanisms of statin action. SPARCL has established that statins have an important role in secondary stroke prevention.

Statins after recent stroke reduces recurrence and improves survival in an aging Mediterranean population without known coronary heart disease

“…This randomized trial of 4731 patients showed that 80 mg of atorvastatin per day significantly reduced the combined absolute incidence of fatal and non‐fatal stroke (3·5% at 5 years) and cardiovascular events, with a minimal increase in the incidence of haemorrhagic stroke 7 . Nevertheless, this study was subjected to numerous qualifications and potential limitations, a circumstance that prompted the conduct of other clinical trials with stroke patient subgroups 8–10 …”

“…7 Nevertheless, this study was subjected to numerous qualifications and potential limitations, a circumstance that prompted the conduct of other clinical trials with stroke patient subgroups. [8][9][10] It is fully established that the use of statins (drugs inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A; HMG-CoA) is an important element in stroke prevention, not only because they reduce stroke recurrence but because they also reduce potential atherosclerotic vascular diseases, 8,11,12 a finding backed by numerous national and international scientific societies. 13,14 Correspondence: Dr A. Sicras-Mainar, Directorate of Planning, Badalona Serveis Assistencials SA, Gaietá Soler, 6-8 entresuelo, 08911 Badalona, Barcelona, Spain.…”

Serum Lipids and Statin Treatment During Acute Stroke

“…The association between statin treatment and intracerebral hemorrhage, especially after publication of the results of the SPARCL study [Goldstein et al, 2008;Goldstein et al, 2009;Welch, 2009], raises the very genuine issue of the adverse event after tPA treatment. Uyttenboogaart et al [2008] analyzed the data of 252 patients treated with tPA.…”

Statintherapy in the primary and the secondary prevention of ischaemic cerebrovascular diseases

“…In the SPARCL trial, the size of the reduction in stroke risk was greater in patients who had carotid stenosis, in those who had an atherothrombotic stroke at entry or diabetes, and in patients who were younger than 65 years. The treatment effect did not significantly differ among any of these subgroups [13][14][15][16][17]. A recent analysis of this trial suggested that the outcome of recurrent ischaemic cerebrovascular events might be improved among statin users as compared with nonusers [18].…”