SPARCL: the glimmer of statins for stroke risk reduction.

Stroke is the third leading cause of mortality in the United States and is associated with grave morbidity and disability. Although dyslipidemias are not as well established as risk factors for stroke, clinical trial data suggest that the incidence of stroke is reduced significantly by the administration of statins. As these risk reductions surpass those expected solely via cholesterol reduction, this has fed the notion of another so-called "pleiotropic" effect of statins. These data, however, only evaluated the risk reduction by statins for first stroke and typically only include stroke as a secondary endpoint. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study was designed to be the first prospective clinical trial to consider risk reduction of recurrent stroke as a primary endpoint. SPARCL revealed that stroke (fatal and nonfatal) was significantly reduced by 16% on atorvastatin therapy. SPARCL not only lent significant additional support to previous clinical trials that demonstrated atorvastatin's capacity to reduce cardiovascular events, but it is also an important contribution to a patient population not typically included in statin trials. The patients enrolled in the SPARCL trial had a threefold lower cardiac event rate and a 10-fold higher annual stroke rate compared with patients in other statin trials, which is why it was so encouraging to see benefit in both of these endpoints. Patients with a history of stroke should be treated much more aggressively with statin therapy in order to more optimally reduce risk for stroke recurrence.