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SPARCL – Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) PowerPoint Presentation
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SPARCL – Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)

SPARCL – Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)

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SPARCL – Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL)

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  1. SPARCL – Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Jim McMorran Coventry GP GP with Specialist Interest in Diabetes and Cardiovascular Risk Coventry PCT

  2. Evidence Base Prior to SPARCL • Primary Prevention of Stroke • 1mmol/l reduction in LDL > 21% reduction in stroke risk • Lipid lowering post cerebrovascular disease • HPS no reduction in the risk of stroke • HPS showed reduction in risk of myocardial infarctions

  3. SPARCL • Double blind randomised – placebo or atorvastatin 80mg • Patients with a history of stroke or TIA 1-6 months prior to study entry (4731) • LDL 2.9 -4.9 mmol/L (3.3 mmol/L) • Exclusions – AF, other cardiac sources of embolism, SAH • Primary end point first fatal or nonfatal stroke • Median follow-up 4.9 years

  4. SPARCL Results • Mean LDL -> atorvastatin 1.9 mmol/l; placebo 3.3 mmol/l • Primary endpoint fatal or nonfatal stroke • 311 (13.1%) placebo group • 265 (11.2%) treatment group (5 year reduction 2.2%) • Hazard ratio 0.84 (0.71-0.99) • Different strokes • Atorvastatin group – 218 ischaemic strokes, 55 haemorrhagic strokes • Placebo – 274 ischaemic strokes, 33 haemorrhagic strokes • 492 >=1 ischaemic stroke, 88 >= 1 haemorrhagic stroke • Reduction in risk of major CV events 3.5% for statin group • Mortality was similar in both groups

  5. SPARCL – adverse events • No significant difference in incidence of adverse events • Persistent raised ALT > x3 normal more frequent in atorvastatin group • 2.2% versus 0.5% • Rhabdomyolysis • 2 cases in statin group, 3 in placebo group • Haemorrhagic stroke • increase in statin group (relative risk increased by 66%) • HPS – patients with cerebrovascular disease increased haemorrhagic stroke • Potential risk of recurrent haemorrhage should be considered in patient with hx of haemorrhagic stroke

  6. SPARCL Results • NNT • 46 patients required to be treated for 5 years in order to prevent one stroke (24-243) • 29 patients required to be treated for 5 years in order to prevent one major cardiovascular event (18-75) • 32 patients required to be treated for 5 years in order to prevent one revascularization procedure (22-59)

  7. Talking points • Why did SPARCL show reduction in recurrent stroke whereas HPS did not? • ? Related to respective reductions in LDL (1.4 mmol/L SPARCL, 1 mmol/L HPS) • HPS enrolled on average 4.3 years after stroke • Could factors such of heterogeneity of patients (cause of stroke, vascular risk) and low rate of primary outcome be influencing significance of results? • stroke and lipids section - General Practice Notebook

  8. SPARCL - Conclusions • Evidence for prevention of recurrent strokes (16% relative reduction) • LDL in treatment group reduced to 1.9 mmol/l (JBS2) • Evidence for reduction in major cardiovascular events (20% relative reduction) • Ischaemic stroke as CHD risk equivalent