Cholesterol-lowering drugs and the risk of hemorrhagic stroke

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Public release date: 12-Dec-2007

http://www.eurekalert.org/pub_releases/2007-12/aaon-cda120607.php

Contact: Babb

ababb@...

American Academy of Neurology

Cholesterol-lowering drugs and the risk of hemorrhagic stroke

ST. PAUL, Minn. – People taking cholesterol-lowering drugs such as

atorvastatin after a stroke may be at an increased risk of hemorrhagic

stroke, or bleeding in the brain, a risk not found in patients taking

statins who have never had a stroke. But researchers caution the risk

must be balanced against the much larger overall benefit of the statin

in reducing the total risk of a second stroke and other cardiovascular

events when making treatment decisions. The research is published in the

December 12, 2007, online issue of Neurology®, the medical journal of

the American Academy of Neurology.

For the study, researchers conducted a secondary analysis of the results

of the Stroke Prevention with Aggressive Reduction in Cholesterol Levels

(SPARCL) clinical trial. The trial enrolled 4,731 people who were within

one to six months of having had a stroke or transient ischemic attack,

or mini-stroke, and with no history of heart disease. Half of the

participants received atorvastatin and half received a placebo. The

participants were then followed for an average of four and a half years.

Overall, treatment was associated with a 16-percent reduction in total

stroke, the study’s primary endpoint, as well as significant reductions

in coronary heart events. However, secondary analysis found that the

overall reduction in stroke included an increase in the risk of brain

hemorrhage. Of those people randomized to atorvastatin, the study found

2.3 percent experienced a hemorrhagic stroke during the study compared

to 1.4 percent of those taking placebo. The study also found there was a

21-percent reduction in ischemic stroke, a more common type of stroke

involving a block in the blood supply to the brain, among people taking

atorvastatin.

Other factors were also found to increase the risk of brain hemorrhage.

For example, those who had experienced a hemorrhagic stroke prior to the

study were more than five times as likely to suffer a second stroke of

this kind. Men were also nearly twice as likely as women to suffer a

hemorrhagic stroke. People with severe high blood pressure at their last

doctor’s visit prior to the hemorrhagic stroke had over six times the

risk of those with normal blood pressure.

“Although treatment of patients with a stroke or transient ischemic

attack was clearly associated with an overall reduction in a second

stroke, hemorrhagic stroke was more frequent in people treated with

atorvastatin, in those with a prior hemorrhagic stroke, in men and in

those with uncontrolled hypertension,” according to study author Larry

B. Goldstein, MD, with Duke University Medical Center in Durham, North

Carolina, and Fellow of the American Academy of Neurology. “This risk of

hemorrhagic stroke also increased with age.”

“Treatment with atorvastatin did not disproportionately increase the

frequency of brain hemorrhage associated with these other factors. The

risk of hemorrhage in patients who have had a transient ischemic attack

or stroke must be balanced against the benefits of cholesterol-lowering

drugs in reducing the overall risk of a second stroke, as well as other

cardiovascular events,” said Goldstein.

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The SPARCL trial was funded by Pfizer, the maker of atorvastatin.

The American Academy of Neurology, an association of more than 20,000

neurologists and neuroscience professionals, is dedicated to improving

patient care through education and research. A neurologist is a doctor

with specialized training in diagnosing, treating and managing disorders

of the brain and nervous system such as stroke, Alzheimer’s disease,

epilepsy, Parkinson disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit

www.aan.com.

--

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