Stroke Patients Benefit From Lipitor
Statin Lowered Second Stroke Risk by 16%
Benefits vs. Risks
Chicago neurologist K. Michael Welch, MB, ChB, who led the investigation, tells WebMD that the findings argue in favor of adding high-dose Lipitor to the regimen of drugs routinely recommended for strokestroke patients.
"The risk following a first stroke is very high, with 40% of patients having a second stroke within five years," he says.
Because the study included only Lipitor and is the first statin trial to include only stroke patients, Welch says it is not clear if other statin drugs would work as well to lower the risk of secondary stroke and heart attackheart attack in this population.
David M. Kent, MD, agrees that the study provides compelling evidence that most stroke patients should be placed on a statin.
But he tells WebMD that the SPARCL trial left many questions unanswered about the benefits vs. the risks of such treatment for specific patient groups.
Kent is an assistant professor of medicine specializing in health policy research at the Tufts-New England Medicine Center in Boston.
It is not clear, for example, if patients who have had strokes caused by the rupture of an artery within the brain benefit from the treatment, he says.
About one in five stroke patients has this type of stroke, known as a hemorrhagic stroke. Most patients have ischemic strokes, which are caused by a clot within an artery in the brain.
"I think it is clear that the default position should be to start patients who have had ischemic strokes on a statin, but this is not clear for hemorrhagic stroke patients," Kent says. Kent notes in his editorial that statins have anticlotting effects and that there was an increased risk for patients in the Lipitor group to have a hemorrhagic stroke.
Unanswered questions aside, Kent says the biggest threat for stroke patients is not overtreatment with a statin, but undertreatment. He makes the point in an editorial accompanying the study.
"In one recent study, even among [hospitalized stroke] patients who were eligible for statin therapy … only a third had discharge medications that included statins," he wrote.