From the Guidelines
After a stroke, high-intensity statin therapy with atorvastatin 80 mg daily is recommended to reduce stroke recurrence, as evidenced by the SPARCL trial and supported by the 2023 systematic review and synthesis of global stroke guidelines 1. The goal of statin therapy after a stroke is to reduce the risk of recurrent stroke and other cardiovascular events by lowering cholesterol levels and through their anti-inflammatory and plaque-stabilizing effects.
- The target LDL-cholesterol level in patients with ischemic stroke and TIA should be < 1.8 mmol/L (70 mg/dL) 1.
- Atorvastatin 80 mg daily has been shown to be effective in reducing stroke recurrence in patients without another indication for statin therapy, as demonstrated by the SPARCL trial 1.
- If a patient cannot tolerate high-intensity statins due to side effects like muscle pain, moderate-intensity options include atorvastatin 10-20 mg, rosuvastatin 5-10 mg, simvastatin 20-40 mg, or pravastatin 40-80 mg daily.
- Regular monitoring of liver function tests and lipid levels is important, with a target LDL cholesterol below 70 mg/dL.
- The 2023 systematic review and synthesis of global stroke guidelines recommends that ischemic stroke and TIA patients without a proven cardioembolic mechanism and an LDL-cholesterol level > 2.5 mmol/L (> 100 mg/dL) should receive atorvastatin 80 mg to reduce stroke recurrence 1.
From the FDA Drug Label
In a post-hoc analysis, atorvastatin calcium 80 mg reduced the incidence of ischemic stroke (9.2% vs. 11.6%) and increased the incidence of hemorrhagic stroke (2.3% vs. 1. 4%) compared to placebo. The recommended statin dose after a stroke is 80 mg of atorvastatin calcium, as it reduced the incidence of ischemic stroke in the SPARCL trial 2.
- Key points:
- The SPARCL trial compared atorvastatin calcium 80 mg to placebo in patients with a stroke or transient ischemic attack (TIA) within the previous 6 months.
- Atorvastatin calcium 80 mg reduced the incidence of ischemic stroke.
- However, it increased the incidence of hemorrhagic stroke, particularly in patients who entered the trial with a hemorrhagic stroke.