PURPOSE OF REVIEW: To assess the potential association between haemorrhagic stroke and achieving very low serum cholesterol levels with aggressive statin treatment. RECENT FINDINGS: The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed a reduction in both fatal and nonfatal stroke but an increase in the risk for haemorrhagic stroke during high-dose atorvastatin treatment. However, post-hoc analyses of this trial showed that this increased risk is primarily observed in elderly men with a history of haemorrhagic stroke. In addition, there was no relationship between baseline or on-treatment low-density lipoprotein cholesterol (LDL-C) levels and haemorrhagic stroke. SUMMARY: Existing data suggest that low LDL-C levels during intensive statin treatment are not associated with an increased risk for haemorrhagic stroke, except in patients with a history of intracerebral haemorrhage. In patients with a history of ischaemic stroke, intensive statin treatment substantially reduces the risk for both recurrent ischaemic stroke and for coronary heart disease (CHD) events. Any possible excess of haemorrhagic stroke is greatly outweighed by the protective effect against ischaemic stroke and CHD events.
PURPOSE OF REVIEW: To assess the potential association between haemorrhagic stroke and achieving very low serum cholesterol levels with aggressive statin treatment. RECENT FINDINGS: The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study showed a reduction in both fatal and nonfatal stroke but an increase in the risk for haemorrhagic stroke during high-dose atorvastatin treatment. However, post-hoc analyses of this trial showed that this increased risk is primarily observed in elderly men with a history of haemorrhagic stroke. In addition, there was no relationship between baseline or on-treatment low-density lipoprotein cholesterol (LDL-C) levels and haemorrhagic stroke. SUMMARY: Existing data suggest that low LDL-C levels during intensive statin treatment are not associated with an increased risk for haemorrhagic stroke, except in patients with a history of intracerebral haemorrhage. In patients with a history of ischaemic stroke, intensive statin treatment substantially reduces the risk for both recurrent ischaemic stroke and for coronary heart disease (CHD) events. Any possible excess of haemorrhagic stroke is greatly outweighed by the protective effect against ischaemic stroke and CHD events.
Authors: Robert P Giugliano; Stephen D Wiviott; Michael A Blazing; Gaetano M De Ferrari; Jeong-Gun Park; Sabina A Murphy; Jennifer A White; Andrew M Tershakovec; Christopher P Cannon; Eugene Braunwald Journal: JAMA Cardiol Date: 2017-05-01 Impact factor: 14.676
Authors: José Rafael Romero; Sarah R Preis; Alexa Beiser; Charles DeCarli; Anand Viswanathan; Sergi Martinez-Ramirez; Carlos S Kase; Philip A Wolf; Sudha Seshadri Journal: Stroke Date: 2014-04-08 Impact factor: 7.914
Authors: Payal Kohli; Nihar R Desai; Robert P Giugliano; Jae B Kim; Ransi Somaratne; Fannie Huang; Beat Knusel; Shannon McDonald; Timothy Abrahamsen; Scott M Wasserman; Robert Scott; Marc S Sabatine Journal: Clin Cardiol Date: 2012-06-19 Impact factor: 2.882