卒中或短暂性脑缺血发作后的大剂量阿伐他汀治疗

BACKGROUND:Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease;whether they reduce the risk of stroke after a recent stroke or transient ischemic attack(TIA)remains to be established.METHODS:We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry,had low-density lipoprotein(LDL)cholesterol levels of 100 to 190 mg per deciliter(2.6 to 4.9 mmol per liter),and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo.The primary end point was a first nonfatal or fatal stroke.RESULTS:The mean LDL cholesterol level during the trial was 73 mg per deciliter(1.9 mmol per liter)among patients receiving atorvastatin and 129 mg per deciliter(3.3 mmol per liter)among patients receiving placebo.During a median follow-up of 4.9 years,265 patients(11.2 percent)receiving atorvastatin and 311 patients(13.1 percent)receiving placebo had a fatal or nonfatal stroke(5-year absolute reduction in risk,2.2 percent;adjusted hazard ratio,0.84;95 percent confidence interval,0.71 to 0.99;P = 0.03;unadjusted P = 0.05).The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes,whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes.The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent(hazard ratio,0.80;95 percent confidence interval,0.69 to 0.92;P = 0.002).The overall mortality rate was similar,with 216 deaths in the atorvastatin group and 211 deaths in the placebo group(P = 0.98),as were the rates of serious adverse events.Elevated liver enzyme values were more common in patients taking atorvastatin.CONCLUSIONS:In patients with recent stroke or TIA and without known coronary heart disease,80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events,despite a small increase in the incidence of hemorrhagic stroke.