Statin Treatment Does Not Lower Risk for Recurrent Stroke in Patients With Type 2 Diabetes or Metabolic Syndrome
Patients with type 2 diabetes or metabolic syndrome did not benefit from treatment with atorvastatin, when compared with patients without either metabolic disorder, according to a study published in the June 13 online Archives of Neurology.
Alfred Callahan, MD, from the Vanderbilt University School of Medicine in Nashville, and colleagues conducted a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial to determine whether the effect of treatment on the primary end point (risk for stroke) and secondary end points (occurrence of coronary and cardiovascular events and procedures) varied based on the presence of type 2 diabetes or metabolic syndrome.
“The SPARCL trial found that statin treatment reduced stroke risk in patients with recent stroke or TIA and no known coronary heart disease (CHD),” Dr. Callahan’s group wrote. “No information is available, however, on the effect of statins on secondary stroke prevention in diabetic patients or in those with metabolic syndrome.”
Of the 4,731 subjects enrolled in the trial, 794 had diabetes and 642 had metabolic syndrome; 3,295 had neither condition and were included as the reference group. All patients were adults who had an ischemic or hemorrhagic stroke or TIA one to six months prior to randomization.
“The risk of stroke was 11.0% in the reference group, 18.1% in subjects with type 2 diabetes, and 10.7% in those with metabolic syndrome,” the investigators reported. “Subjects with type 2 diabetes mellitus were more likely to have any of the primary and secondary end points, including death.” Patients with metabolic syndrome had no increase in the risk of major cardiovascular events or major coronary events, but they were more likely to have any CHD event or revascularization procedure.
“In this post hoc analysis, we found that SPARCL subjects with type 2 diabetes mellitus were at higher risk for recurrent stroke and cardiovascular events but that there was no difference in the effect of statin treatment in reducing these events in subjects with or without type 2 diabetes or metabolic syndrome,” the authors concluded. They also noted that the possibility of variation on the benefit of statin treatment in subjects with or without type 2 diabetes or metabolic syndrome cannot be excluded by their analysis.
Callahan A, Amarenco P, Goldstein LB, et al. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: Secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Arch Neurol. 2011 Jun 13; [Epub ahead of print].
Does Stress Increase the Risk for Multiple Sclerosis?
Daily life- and work-related stress and childhood trauma have no significant impact on increasing the risk of developing multiple sclerosis (MS), according to a study published in the May 31 issue of Neurology.
“Several studies have shown that stressful life events are associated with a subsequent significant increase in risk of MS exacerbations,” the authors wrote. “We wanted to study prospectively whether stress can increase the risk of developing the disease itself.”
Trond Riise, PhD, from the Department of Public Health and Primary Health Care at the University of Bergen in Norway, and colleagues analyzed questionnaires regarding stress at work and home and the effects of physical and sexual abuse in childhood and adolescence completed by women in the Nurses’ Health Study and Nurses’ Health Study II who developed MS during the study period. They then conducted separate analyses by levels of stress and by severity of childhood abuse to calculate incidence rates and hazard ratios of MS.
“Stress measurements were available for 77 of the 94 women who had developed MS,” the researchers reported. “Adjusting for age, ethnicity, latitude at birth, BMI at age 18, and biannually updated smoking status, there were no significant differences in the risk of MS between any of the levels of stress at home or at work.” Of the 292 women from the Nurses’ Health Study II who responded to questions about childhood trauma, 7% reported severe abuse; there was no significant increased risk.
The lack of a significant relationship between stress and trauma and the risk for MS could potentially be caused by the study’s retrospective design. “A major challenge when studying this relation is to achieve unbiased measurement of stress,” the authors explained. “The possibility that these assessments were not sensitive to the stressors and stress mechanisms that might increase risk of developing MS cannot be ruled out.
“These results do not support a major role of stress [for developing MS], but repeated and more focused measures of stress are needed to firmly exclude stress as a potential risk factor for MS,” the investigators concluded.
Riise T, Mohr DC, Munger KL, et al. Stress and the risk of multiple sclerosis. Neurology. 2011;76(22);1866-1871.