Coronary Heart Disease Risk in Patients With Stroke or Transient Ischemic Attack and No Known Coronary Heart Disease Findings From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial
Coronary Heart Disease Risk in Patients With Stroke or Transient Ischemic Attack and No Known Coronary Heart Disease Findings From the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial
复制标题
DOI：
10.1161/strokeaha.109.564781
复制
发表时间：
2010-03-01
期刊：
影响因子：
8.3
通讯作者：
Welch, K. Michael A.
中科院分区：
文献类型：
--
作者：
Amarenco, Pierre;Goldstein, Larry B.;Welch, K. Michael A.
背景和目的：非冠状动脉形式的动脉粥样硬化(包括短暂性脑缺血发作或颈动脉起源的中风或颈动脉50%狭窄)与10年血管风险20%相关，从血脂管理的角度来看，被认为是与冠心病(CHD)风险相当的疾病。通过积极降低胆固醇水平预防中风(SPARCL)试验包括中风或短暂性脑缺血发作的患者，并且无论是否存在颈动脉粥样硬化，都没有已知的冠心病。我们评估了SPARCL患者发生临床公认的冠心病的风险。方法：总共4731名患者(平均年龄63岁)被随机分为80 mg/d的阿托伐他汀安慰剂。结果：经过4.9年的随访，安慰剂组发生重大冠状动脉事件和发生任何冠心病终点的风险分别为5.1%和8.6%。中风的转化率随着时间的推移而下降，而主要冠状动脉事件的发生率是稳定的。与基线时有大血管相关卒中的患者相比，那些有短暂性脑缺血发作、出血性卒中、小血管卒中或不明原因卒中的患者首次发生重大冠状动脉事件和发生任何冠心病事件的绝对率相似；短暂性脑缺血发作、小血管和不明原因组的绝对血运重建率较低。与安慰剂组相比，阿托伐他汀组的所有基线卒中亚型患者的主要冠状动脉事件、任何CHD事件和任何血管重建手术的发生率与安慰剂组相比都有类似的降低。结论：无论卒中亚型如何，阿托伐他汀治疗近期卒中或短暂性脑缺血发作的患者都可以显著降低CHD风险。(笔划。2010；41：426-430。)
Background and Purpose-Noncoronary forms of atherosclerosis (including transient ischemic attacks or stroke of carotid origin or >50% stenosis of the carotid artery) are associated with a 10-year vascular risk of >20% and are considered as a coronary heart disease (CHD) -risk equivalent from the standpoint of lipid management. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial included patients with stroke or transient ischemic attack and no known CHD regardless of the presence of carotid atherosclerosis. We evaluated the risk of developing clinically recognized CHD in SPARCL patients.Methods-A total of 4731 patients (mean age, 63 years) was randomized to 80 mg/day atorvastatin placebo. The rates of major coronary event, any CHD event, and any revascularization procedure were evaluated.Results-After 4.9 years of follow-up, the risks of a major coronary event and of any CHD end point in the placebo group were 5.1% and 8.6%, respectively. The rate of outcome of stroke decreased over time, whereas the major coronary event rate was stable. Relative to those having a large vessel-related stroke at baseline, those having a transient ischemic attack, hemorrhagic stroke, small vessel stroke, or a stroke of unknown cause had similar absolute rates for a first major coronary event and for any CHD event; transient ischemic attack, small vessel, and unknown cause groups had lower absolute revascularization procedure rates. Major coronary event, any CHD event, and any revascularization procedure rates were similarly reduced in all baseline stroke subtypes in the atorvastatin arm compared with placebo with no heterogeneity between groups.Conclusion-CHD risk can be substantially reduced by atorvastatin therapy in patients with recent stroke or transient ischemic attack regardless of stroke subtype. (Stroke. 2010;41:426-430.)