Atorvastatin Reduces First and Subsequent Vascular Events Across Vascular Territories: The SPARCL Trial

Michael Szarek, Pierre Amarenco, Alfred Callahan, David DeMicco, Rana Fayyad, Larry B Goldstein, Rachel Laskey, Henrik Sillesen, K Michael Welch, SPARCL Committees and Investigators


BACKGROUND: In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, atorvastatin was compared with placebo in 4,731 participants with recent stroke or transient ischemic attack and no known coronary heart disease. Atorvastatin reduced the first occurrence of stroke and the first occurrence of a composite of vascular events.

OBJECTIVES: The aim of this post hoc analysis was to assess the occurrence of all (first and subsequent) vascular events and the effect of atorvastatin to reduce these events by vascular territory (cerebrovascular, coronary, or peripheral) in SPARCL.

METHODS: Treatment effects on total adjudicated vascular events, overall and by vascular territory, were summarized by marginal proportional hazards models. Vascular event rates were estimated for each treatment group with cumulative incidence functions.

RESULTS: The placebo group had an estimated 41.2 first and 62.7 total vascular events per 100 participants over 6 years. There were 164 fewer first and 390 fewer total vascular events in the atorvastatin group (total events hazard ratio: 0.68; 95% confidence interval: 0.60 to 0.77). The total events reduction included 177 fewer cerebrovascular, 170 fewer coronary, and 43 fewer peripheral events. Over 6 years, an estimated 20 vascular events per 100 participants were avoided with atorvastatin treatment.

CONCLUSIONS: In participants with recent stroke or transient ischemic attack, the total number of vascular events prevented with atorvastatin was more than twice the number of first events prevented. Total event reduction provides a comprehensive metric to capture the totality of atorvastatin clinical efficacy in reducing disease burden after stroke or transient ischemic attack. (Lipitor in the Prevention of Stroke, for Patients Who Have Had a Previous Stroke [SPARCL]; NCT00147602).

Original languageEnglish
JournalJournal of the American College of Cardiology
Issue number17
Pages (from-to)2110-2118
Number of pages9
Publication statusPublished - 5 May 2020


  • Atorvastatin/therapeutic use
  • Cholesterol, LDL/blood
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
  • Ischemic Attack, Transient/blood
  • Male
  • Stroke/blood
  • Treatment Outcome


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