Preventing recurrent stroke with a cholesterol lowering medicine

August 10, 2006 issue of New England Journal of Medicine recently published a study named SPARCL (the stroke prevention by aggressive reduction in cholesterol levels).

 Following are the salient points:

1. This study applies to those who have already had a stroke or Transient ischemic attack (TIA).
2. A high dose (80 mg) of Atorvastatin, marketed as Lipitor® was used in these cases. Lipitor® belongs to a group of cholesterol lowering medicines called statins.
3. This study showed reduction in chances of another ischemic stroke. Ischemic stroke is the stroke caused by lack of blood supply to the brain
4. This study however did show increased chance of stroke due to hemorrhage in patients on Atorvastatin. Some epidemiological studies in the past have shown association between low cholesterol level and brain hemorrhage.
5. The study subjects had a bad cholesterol (LDL) level above 100 mg per deciliter. The NCEP guidelines suggest an LDL level of less than 100.
6. As compared to control group, a higher (2.2%) percentage of subjects in Atorvastatin group had blood abnormalities suggestive of liver damage.
7. The results of this study contrast with those of Heart Protection Study (HPS) where statins did not reduce a chance of recurrent stroke in patients with evidence of previous stroke.

 Action Points:

• If you have had a stroke, you should shoot for LDL level less than 100 as suggested by NCEP (National cholesterol education program) guidelines
• This can be achieved with one of the statins. Fortunately, three of the statins are now generic. See some money saving tips when buying statins
• Unlike this study, I almost never start my patients on the highest dose of cholesterol lowering medicines for the fear of causing lot of side effects. I will still recommend dose titration to the level that brings cholesterol to the desired level.