Goldstein L B, Amarenco P, Szarek M, Callahan A, Hennerici M, Sillesen H, Zivin J A, Welch K M A
Duke University Medical Center, Durham, NC 27710, USA.
Neurology. 2008 Jun 10;70(24 Pt 2):2364-70. doi: 10.1212/01.wnl.0000296277.63350.77. Epub 2007 Dec 12.
In the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study, atorvastatin 80 mg/day reduced the risk of stroke in patients with recent stroke or TIA. Post hoc analysis found this overall benefit included an increase in the numbers of treated patients having hemorrhagic stroke (n = 55 for active treatment vs n = 33 for placebo).
We explored the relationships between hemorrhage risk and treatment, baseline patient characteristics, most recent blood pressure, and most recent low-density lipoprotein (LDL) cholesterol levels prior to the hemorrhage.
Of 4,731 patients, 67% had ischemic strokes, 31% TIAs, and 2% hemorrhagic strokes as entry events. In addition to atorvastatin treatment (HR 1.68, 95% CI 1.09 to 2.59, p = 0.02), Cox multivariable regression including baseline variables significant in univariable analyses showed that hemorrhagic stroke risk was higher in those having a hemorrhagic stroke as the entry event (HR 5.65, 95% CI 2.82 to 11.30, p < 0.001), in men (HR 1.79, 95% CI 1.13 to 2.84, p = 0.01), and with age (10 y increments, HR 1.42, 95% CI 1.16 to 1.74, p = 0.001). There were no statistical interactions between these factors and treatment. Multivariable analyses also found that having Stage 2 (JNC-7) hypertension at the last study visit before a hemorrhagic stroke increased risk (HR 6.19, 95% CI 1.47 to 26.11, p = 0.01), but there was no effect of most recent LDL-cholesterol level in those treated with atorvastatin.
Hemorrhagic stroke was more frequent in those treated with atorvastatin, in those with a hemorrhagic stroke as an entry event, in men, and increased with age. Those with Stage 2 hypertension at the last visit prior to the hemorrhagic stroke were also at increased risk. Treatment did not disproportionately affect the hemorrhagic stroke risk associated with these other factors. There were no relationships between hemorrhage risk and baseline low-density lipoprotein (LDL) cholesterol level or recent LDL cholesterol level in treated patients.
在强化降低胆固醇水平预防卒中（SPARCL）研究中，阿托伐他汀80毫克/天可降低近期发生卒中或短暂性脑缺血发作（TIA）患者的卒中风险。事后分析发现，这一总体益处包括出血性卒中治疗患者数量增加（活性治疗组为55例，安慰剂组为33例）。
我们探讨了出血风险与治疗、基线患者特征、最近血压以及出血前最近的低密度脂蛋白（LDL）胆固醇水平之间的关系。
在4731例患者中，67%发生缺血性卒中，31%发生TIA，2%发生出血性卒中作为入组事件。除阿托伐他汀治疗外（风险比[HR]1.68，95%置信区间[CI]1.09至2.59，p = 0.02），纳入单变量分析中有显著意义的基线变量的Cox多变量回归显示，以出血性卒中作为入组事件的患者出血性卒中风险更高（HR 5.65，95%CI 2.82至11.30，p < 0.001），男性患者风险更高（HR 1.79，95%CI 1.13至2.84，p = 0.01），且风险随年龄增加（每增加10岁，HR 1.42，95%CI 1.16至1.74，p = 0.001）。这些因素与治疗之间无统计学交互作用。多变量分析还发现，在出血性卒中前最后一次研究访视时患有2期（美国国家联合委员会第7版[JNC - 7]）高血压会增加风险（HR 6.19，95%CI 1.47至26.11，p = 0.01），但阿托伐他汀治疗患者的最近LDL胆固醇水平对此无影响。
接受阿托伐他汀治疗的患者、以出血性卒中作为入组事件的患者、男性患者以及出血性卒中风险随年龄增加。在出血性卒中前最后一次访视时患有2期高血压的患者风险也增加。治疗并未对与这些其他因素相关的出血性卒中风险产生不成比例的影响。在接受治疗的患者中，出血风险与基线低密度脂蛋白（LDL）胆固醇水平或最近的LDL胆固醇水平之间无关联。
