Cerebrovascular disease and statins: a potential addition to the therapeutic armamentarium for stroke prevention

Cerebrovascular disease is the leading cause of disability in Western societies. In the United States, it has been estimated that a stroke occurs every 53 seconds. Consequently, the societal costs attributable to cerebrovascular disease are immense and encourage the medical community to seek new therapies that can reduce stroke’s frequency and impact. Although serum lipid levels have not been shown to act as a surrogate marker for stroke, in landmark lipid-lowering trials, statin therapy has been associated with reductions in the incidence of ischemic stroke in patient populations with manifest ischemic heart disease. This observation is supported by a recently published meta-analysis of statin trials that reported an average reduction of about 30% in the incidence of cerebrovascular disease. However, to date, statin studies have only been conducted in patients with, or at high risk for coronary artery disease, who are not truly representative of the overall stroke population. The ongoing Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial has been designed to prospectively evaluate the benefits of aggressive lipid-lowering therapy on cerebrovascular events in patients who have had a previous stroke or transient ischemic attack, but who have no prior history of coronary artery disease.