"Atorvastatin for Stroke Prevention".The New England Journal of Medicine. 2006. 355(6):549-559. PubMed • Full text • PDF

Contents

1 Clinical Question
2 Bottom Line
3 Major Points
4 Guidelines
5 Design
6 Population
6.1 Inclusion Criteria
6.2 Exclusion Criteria
6.3 Baseline Characteristics
7 Interventions
8 Outcomes
8.1 Primary Outcome
8.2 Secondary Outcomes
9 Criticisms
10 Funding
11 Further Reading

Clinical Question

In patients with recent stroke or TIA and without known coronary heart disease, does atorvastatin reduce the risk of subsequent strokes or cardiovascular events?

Bottom Line

In patients with recent stroke or TIA and without known coronary heart disease, daily treatment with 80 mg of atorvastatin reduced the overall incidence of strokes and major cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.

Major Points

Guidelines

Design

Randomized, double-blind, placebo-controlled trial.

Population

Inclusion Criteria:
- Age >18 years
- Stroke or TIA within one to six months of study entry
- LDL cholesterol levels 100-190 mg/dL
- No known coronary heart disease

Exclusion Criteria:
- Atrial fibrillation, other cardiac sources of embolism, and subarachnoid hemorrhage

Baseline Characteristics:
- Mean age: ~63 years
- 60% male
- Median LDL cholesterol: ~133 mg/dL
- Previous stroke: 66%

Interventions

- Atorvastatin 80 mg per day versus placebo

Outcomes

Primary Outcome:
- First nonfatal or fatal stroke

Secondary Outcomes:
- Stroke or TIA
- Major coronary event
- Major cardiovascular event
- Acute coronary event
- Any coronary event
- Revascularization procedure
- Any cardiovascular event

Criticisms

- Increased risk of hemorrhagic stroke

Funding

Supported by Pfizer.

Further Reading

ClinicalTrials.gov number, NCT00147602