In patients with no known coronary heart disease who had a recent stroke or transient ischemic attack, intensive atorvastatin therapy, compared with placebo, reduced the first occurrence of stroke and the first composite vascular events, according to results from the SPARCL study presented during ACC.20/WCC and simultaneously published March 16 in the Journal of the American College of Cardiology.

This post hoc analysis examined the first and total (first and subsequent) vascular events in 4,731 participants who were randomized to atorvastatin 80 mg daily vs. placebo. The primary efficacy endpoint of SPARCL was time to occurrence of the first fatal or nonfatal stroke.

Results showed that over six years, per 100-participants, there were an estimated 41.2 first and 62.7 total vascular events with placebo and 164 fewer first and 390 fewer total vascular events with atorvastatin (total events hazard ratio, 0.68; 95% confidence interval 0.60 to 0.77). For total event reduction, with atorvastatin there were 177 fewer cerebrovascular, 170 fewer coronary, and 43 fewer peripheral events. An estimated 20 vascular events per 100-participants were avoided using the atorvastatin treatment.

Overall, write the authors, the total number of vascular events prevented with atorvastatin was more than twice the number of first events prevented, which included significant reductions in total cerebrovascular, total coronary, and total peripheral events.

"Future trials of intensive lipid-lowering strategies should compare treatment effects on disease burden, as quantified by total vascular events, in high-risk patient populations," they write.

Looking ahead, they write, "Given these observations, reduction in total events may be considered another important measure reflecting the clinical benefit and efficiency of atorvastatin treatment in reducing disease burden in this setting."

Keywords: acc20, ACC Annual Scientific Session, Coronary Disease, Ischemic Attack, Transient

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