High Doses of Lipitor® May Prevent a Second Stroke

Statins have been shown to reduce the risk of stroke in patients with established cardiovascular disease, but it was not known if the same protective effect would occur in patients without heart disease A new study published in the New England Journal of Medicine measured the ability of Lipitor® (atorvastatin) to prevent a second stroke or transient ischemic attack (TIA) in patients with no known coronary heart disease.¹ 

In this double blind, placebo controlled trial funded by Pfizer Inc., 80mg of atorvastatin or placebo was administered per day to patients with LDL cholesterol levels between 100 and 190 mg per deciliter within 1 to 6 months of their first stroke or TIA.¹ The results showed that the 5-year absolute risk reduction for stroke was 2.2 %, with a 16% relative reduction in risk of fatal or nonfatal stroke.^1,3  The rate of cardiovascular events was also decreased with atorvastatin; however, there was no significant difference in the number of deaths with atorvastatin or placebo.^1,2,3  “You can’t say from this study that people placed on this regimen live longer, but you can argue that they live better, from fewer strokes and other cardiovascular complications,” said Dr. Robert Adams, a Medical College of Georgia neurologist.² 

The positive effects of atorvastatin on patients in this study are very encouraging and have prompted some doctors to call for revisions to current therapy guidelines.  It must be noted, however, that atorvastatin was also found to slightly increase the risk of hemorrhagic stroke.^1,2,3   David M. Kent, M.D., of the Institute for Clinical Research and Health Policy Studies at Tufts-New England Medical Center in Boston, does not think revisions to current therapy recommendations need to be made yet.  He stated that "the relative risk of hemorrhagic stroke was increased by 66% among patients in the Lipitor arm, an effect that is likely to be of some import among patients presenting with a hemorrhagic stroke." ³

Future studies will need to be conducted to strengthen these findings.  However, the published results are promising and may offer hope to patients at risk for a second stroke.

References

1.  Amaranco P, Bogousslavsky J, Callahan A 3^rd, Goldstein LB, Hennerici M, Rudolph AE, Sillesen H, Simunovic L, Szarek M, Welch KM, Zivin JA.  “High dose atorvastatin after stroke or transient ischemic attack.”N Engl J Med. 2006 Aug 10;355(6):549-59.
2. The Associated Press.  “Cholesterol Drugs Cut Risk of Second Stroke.”  August 9, 2006.  Accessed on September 12, 2006 at http://www.msnbc.msn.com/id/14270621/.
3. Peck P.  “High Dose Statins Following a Stroke Can Prevent a Second.”  August 9, 2006.  Accessed on September 12, 2006 at http://www.medpagetoday.com/Neurology/Strokes/tb/3893.

Becky Rogers, PharmD. Candidate