A better understanding of statins for secondary stroke prevention.

For patients hospitalized with stroke, should we be prescribing high dose statins at discharge, in an attempt to reduce their risk of recurrent stroke? As we recall the results of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial (4731 patients with prior stroke or TIA with no known CAD, randomized to atorvastatin 80 or placebo) (abstract), statin patients had a 16% lower risk of overall stroke, but a significantly higher risk of non-fatal hemorrhagic stroke (55 vs 33 patients). To help further understand those 88 hemorrhagic stroke patients, researchers performed a post hoc analysis to define their risk for hemorrhage. They found prior hemorrhagic stroke, male sex, older age, and stage 2 (JNC 7) hypertension were associated with hemorrhagic stroke (abstract). Editorialists surmise that, for patients without these risk factors, the benefits of statins for secondary stroke prevention clearly outweigh the risks. For those with prior hemorrhagic stroke or older hypertensive men, the risks and benefits are less clear, and need to be very carefully weighed (editorial)

Danielle Scheurer

Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.

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