SPARCL and hemorrhagic stroke

Article and editorial in Neurology 2008 70:24 June 10. In SPARCL 4734 patients were randomized to 80 mh atorvastatin or placebo. Patients had 16 percent reduction in stroke risk over five years (absolute risk reduction 1.9 percent). Posthoc analysis showed increased amount of hemorrhagic stroke. 55 patients in the treated group (2.3%) v. 33 of placebo group (1.4 percent) had hemorrhagic stroke. Those 88 patients were also associated with male sex, older age and hemorrhagic stroke at study entry, and uncontrolled hypertension. Study does not indicate that lower cholesterol is related to stroke. It may be due to antithrombotic mechanism of statins (reducing thromboxane A2, thrombin formation, or blood viscosity) or some other mechanism. It may affect arterioles or be related to amyloid angiopathy. It remains a "mystery." In most strokes statins still have benefits that outweigh the risks. In patients with past hemorrhagic stroke, the risk and benefit is less well defined.