Chaturvedi S, Zivin J, Breazna A, Amarenco P, Callahan A, Goldstein L B, Hennerici M, Sillesen H, Rudolph A, Welch M A
Stroke Program and Department of Neurology, Wayne State University, Detroit, MI 48201, USA.
Neurology. 2009 Feb 24;72(8):688-94. doi: 10.1212/01.wnl.0000327339.55844.1a. Epub 2008 Sep 3.
It is unclear whether patients age 65 years and over with a recent stroke or TIA benefit from statin treatment to a similar degree as younger patients.
The 4,731 patient cohort in the SPARCL study was divided into an elderly group (65 and over) and a younger group. The primary endpoint (fatal or nonfatal stroke) and secondary endpoints were analyzed, with calculation of the hazard ratio (HR) and p values from a Cox regression model.
There were 2,249 patients in the elderly group and 2,482 in the younger group. The baseline LDL (133 mg/dL) and total cholesterol were comparable in the two groups. The elderly and younger groups had a 61.4 mg/dL and 58.7 mg/dL decrease in mean LDL during the trial. The primary endpoint was reduced by 26% in younger patients (HR 0.74, 0.57-0.96, p = 0.02) and by 10% in elderly subjects (HR 0.90, 0.73-1.11, p = 0.33). A test of heterogeneity for a treatment-age interaction was not significant (p = 0.52). The risk of stroke or TIA (HR 0.79, p = 0.01), major coronary events (HR 0.68, p = 0.035), any coronary heart disease event (HR 0.61, p = 0.0006), and revascularization procedures (HR 0.55, p = 0.0005) was reduced in the elderly group.
There was no heterogeneity in the stroke reduction seen with atorvastatin in the elderly and younger groups. Cardiac events and revascularization procedures were also lower in both the elderly and younger subgroups treated with atorvastatin. These results support the use of atorvastatin in elderly patients with recent stroke or TIA.
65岁及以上近期发生中风或短暂性脑缺血发作（TIA）的患者从他汀类药物治疗中获益的程度是否与年轻患者相似尚不清楚。
SPARCL研究中的4731名患者队列被分为老年组（65岁及以上）和年轻组。分析主要终点（致命或非致命性中风）和次要终点，并通过Cox回归模型计算风险比（HR）和p值。
老年组有2249名患者，年轻组有2482名患者。两组的基线低密度脂蛋白（LDL，133mg/dL）和总胆固醇相当。试验期间，老年组和年轻组的平均LDL分别降低了61.4mg/dL和58.7mg/dL。年轻患者的主要终点降低了26%（HR 0.74，0.57 - 0.96，p = 0.02），老年受试者降低了10%（HR 0.90，0.73 - 1.11，p = 0.33）。治疗 - 年龄交互作用的异质性检验无显著性（p = 0.52）。老年组中风或TIA的风险（HR 0.79，p = 0.01）、主要冠状动脉事件（HR 0.68，p = 0.035）、任何冠心病事件（HR 0.61，p = 0.0006）和血运重建手术（HR 0.55，p = 0.0005）均降低。
阿托伐他汀在老年组和年轻组中降低中风的效果不存在异质性。阿托伐他汀治疗的老年和年轻亚组的心脏事件和血运重建手术也较少。这些结果支持在近期发生中风或TIA的老年患者中使用阿托伐他汀。
