SEATTLE—Achieving optimal levels of LDL cholesterol, HDL cholesterol, triglycerides, and blood pressure reduces a person’s risk of recurrent stroke and major cardiovascular events, according to a new analysis of data from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. The more optimally controlled risk factors that a patient has, the greater the reduction in stroke risk that he or she will experience, reported lead investigator Pierre Amarenco, MD, who presented the findings at the 61st Annual Meeting of the American Academy of Neurology.
In the SPARCL study, 4,731 patients with recent stroke or transient ischemic attack and no known coronary heart disease were randomized to atorvastatin (80 mg/day) or placebo. Dr. Amarenco and colleagues found that after an average of 4.9 years, at each level of LDL cholesterol reduction, patients with HDL cholesterol levels above the median or systolic blood pressure below the median had greater reductions in stroke and major cardiovascular events. Similar trends were seen in subjects with triglyceride levels above the median or diastolic blood pressure below the median, said Dr. Amarenco, Professor of Neurology and Chairman of the Department of Neurology and Stroke Center, Bichat Univeristy Hospital, Denis Diderot University, Paris.
Optimal Control of Risk Factors
In additional exploratory analyses, the investigators examined the individual and cumulative effects of optimally controlled risk factors on risk for recurrent stroke. Optimal control was defined as an LDL cholesterol level of less than 70 mg/dL, an HDL cholesterol level of more than 50 mg/dL, a triglyceride level of less than 150 mg/dL, and a blood pressure level of less than 120/80 mm Hg.
The researchers found that the risk of stroke decreased as the level of control increased; for patients achieving optimal control of one, two, three, or four risk factors, hazard ratios were 0.98, 0.78, 0.68, and 0.35, respectively. Results were similar for major cardiovascular events, noted Dr. Amarenco.
“We found a dose-response relationship with patients achieving the four parameters having a 65% reduction in stroke risk and a 75% reduction in major cardiovascular events,” said Dr. Amarenco.
Reducing Risk of Stroke and Cardiovascular Events
“These results show that there is a cumulative effect to lowering cholesterol and blood pressure,” said Dr. Amarenco. “We can now tell [patients] that if they are adherent to the treatment and follow the target recommendation we made to them, it may reduce their risk of stroke by 65% and the risk of major cardiovascular events by 75%.”
In addition, Dr. Amarenco said that physicians should implement guideline recommendations as well as develop strategies to improve adherence.
One such strategy would be a prevention clinic, in which a nurse practitioner would monitor patients during the year following the initial stroke to ensure that patients are following recommendations and achieving target levels of LDL cholesterol, HDL cholesterol, triglycerides, and blood pressure.
—Karen L. Spittler