Department of Neurology and Stroke Centre, INSERM U-698 and Denis Diderot University-Paris VII, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75018 Paris, France.
Stroke. 2010 Mar;41(3):426-30. doi: 10.1161/STROKEAHA.109.564781. Epub 2010 Jan 28.
Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients.
A total of 4731 patients (mean age, 63 years) was randomized to 80 mg/day atorvastatin placebo. The rates of major coronary event, any CHD event, and any revascularization procedure were evaluated.
After 4.9 years of follow-up, the risks of a major coronary event and of any CHD end point in the placebo group were 5.1% and 8.6%, respectively. The rate of outcome of stroke decreased over time, whereas the major coronary event rate was stable. Relative to those having a large vessel-related stroke at baseline, those having a transient ischemic attack, hemorrhagic stroke, small vessel stroke, or a stroke of unknown cause had similar absolute rates for a first major coronary event and for any CHD event; transient ischemic attack, small vessel, and unknown cause groups had lower absolute revascularization procedure rates. Major coronary event, any CHD event, and any revascularization procedure rates were similarly reduced in all baseline stroke subtypes in the atorvastatin arm compared with placebo with no heterogeneity between groups.
CHD risk can be substantially reduced by atorvastatin therapy in patients with recent stroke or transient ischemic attack regardless of stroke subtype.
非冠状动脉粥样硬化（包括颈动脉起源的短暂性脑缺血发作或脑卒中或颈动脉狭窄＞50%）与 10 年内血管风险＞20%相关，从血脂管理的角度来看，可被视为冠心病（CHD）的等效风险。卒中预防的降脂治疗（SPARCL）试验纳入了无论是否存在颈动脉粥样硬化，均有卒中或短暂性脑缺血发作但无已知 CHD 的患者。我们评估了 SPARCL 患者发生临床上公认的 CHD 的风险。
共 4731 例患者（平均年龄 63 岁）随机分为阿托伐他汀 80 mg/天安慰剂组。评估了主要冠状动脉事件、任何 CHD 事件和任何血运重建的发生率。
随访 4.9 年后，安慰剂组主要冠状动脉事件和任何 CHD 终点的风险分别为 5.1%和 8.6%。随着时间的推移，脑卒中结局的发生率降低，而主要冠状动脉事件的发生率则保持稳定。与基线时发生大血管相关脑卒中的患者相比，发生短暂性脑缺血发作、出血性脑卒中、小血管脑卒中或不明原因脑卒中的患者，首次发生主要冠状动脉事件和任何 CHD 事件的绝对发生率相似；短暂性脑缺血发作、小血管和不明原因组的绝对血运重建术发生率较低。与安慰剂相比，阿托伐他汀组所有基线脑卒中亚型的主要冠状动脉事件、任何 CHD 事件和任何血运重建术的发生率均显著降低，且组间无异质性。
无论脑卒中亚型如何，近期发生脑卒中或短暂性脑缺血发作的患者应用阿托伐他汀治疗可显著降低 CHD 风险。
