Statins

HMG CoA reductase inhibitors, or statins, are mainstay drugs for managing ischemic cardiovascular disease. Based upon the results of multiple large randomized clinical trials of statins in a variety of cohorts, there is ironclad evidence that statins reduce ischemic cardiovascular endpoints1 and have a similar benefit in reducing stroke risk.2 Since these clinical trials were primarily focused on coronary heart disease, the question remained as to whether statins would be equally effective for secondary stroke prevention in individuals who did not have a cardiovascular indication, a previous gap in the evidence. This important question was addressed in the Stroke Prevention by Aggressive Lowering of Cholesterol (SPARCL) trial,3 a large international trial in which adults with a stroke or TIA but no known coronary heart disease were randomly assigned to receive daily doses of either atorvastatin 80 mg or placebo. After a mean follow-up of 4.9 years, there was a 16% relative risk reduction in favor of atorvastatin for the primary endpoint of fatal and nonfatal stroke (HR 0.84; 95% CI 0.71–0.99; p = 0.03). Atorvastatin also reduced major coronary events. Although some believe …