Abstract 2985: Lipoprotein, Blood Pressure and Stroke Risk: Findings from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study
Introduction: The SPARCL trial showed significant reductions in the risk of stroke (16%) and major coronary events (MCE, CHD death, non-fatal MI and resuscitated cardiac arrest, 35%) in patients with recent stroke or transient ischemic attack (TIA) treated with atorvastatin 80 mg/day compared with placebo. We evaluated the relationships between baseline and month 1 HDL-C, LDL-C, and systolic blood pressures (SBP) and the risk of stroke and MCE.
Methods: 4731 patients with a stroke or TIA within 6 months and no history of CHD were randomized to atorvastatin 80 mg/day or placebo and followed for a median of 4.9 years. Relationships between continuous baseline and month 1 LDL-C, HDL-C and SBP, and the risk of stroke and MCE were determined in separate models using Cox regression with adjustment for geographical region, entry event, time since entry event, sex and baseline age.
Results: Hazard ratios per 1 standard deviation (SD) increment in each factor are summarized below. Baseline LDL-C was not associated with the risk of stroke or MCE, but month 1 LDL-C was a predictor of these events. A 10% reduction in LDL-C from baseline to month 1 was associated with a 4% (p = 0.005) reduction in the risk of stroke and a 7% (p = 0.004) reduction in the risk of MCE. Higher baseline and month 1 HDL-C were associated with a lower risk of stroke and trends towards a lower risk of MCEs. Higher SBPs at these timepoints were associated with trends towards an increased risk of stroke, and an increased risk of MCEs, respectively.
Conclusions: In patients with recent stroke or TIA and no CHD, lower baseline HDL-C predicted the risk of stroke and higher baseline SBP predicted the risk of MCEs. Baseline LDL levels were not related to risk, whereas greater reductions in month 1 LDL-C were directly correlated with greater reductions in the risk of stroke and MCE.