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Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.

Publication ,  Journal Article
Callahan, A; Amarenco, P; Goldstein, LB; Sillesen, H; Messig, M; Samsa, GP; Altafullah, I; Ledbetter, LY; MacLeod, MJ; Scott, R; Hennerici, M ...
Published in: Arch Neurol
October 2011

OBJECTIVE: To perform a secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial, which tested the effect of treatment with atorvastatin in reducing stroke in subjects with a recent stroke or transient ischemic attack, to explore the effects of treatment in subjects with type 2 diabetes mellitus or metabolic syndrome (MetS). METHODS: The 4731 subjects enrolled in the SPARCL trial were classified as having type 2 diabetes mellitus at enrollment (n = 794), MetS retrospectively (n = 642), or neither diabetes nor MetS (n = 3295, the reference group) based on data collected at baseline. Cox regression models were used to determine whether the effect of treatment on the primary end point (combined risk of nonfatal and fatal stroke) and secondary end points (major coronary events, major cardiovascular events, any coronary heart disease event, and any revascularization procedure) varied based on the presence of type 2 diabetes mellitus or MetS. RESULTS: Subjects with type 2 diabetes mellitus had increased risks of stroke (hazard ratio [HR] = 1.62; 95% confidence interval [CI], 1.33-1.98; P < .001), major cardiovascular events (HR = 1.66; 95% CI, 1.39-1.97; P < .001), and revascularization procedures (HR = 2.39; 95% CI, 1.78-3.19; P < .001) compared with the reference group. Subjects with MetS were not at increased risk for stroke (P = .78) or major cardiovascular events (P = .38) but more frequently had revascularization procedures (HR = 1.78; 95% CI, 1.26-2.5; P = .001). There were no treatment × subgroup interactions for the SPARCL primary end point (P = .47). CONCLUSIONS: The SPARCL subjects with type 2 diabetes were at higher risk for recurrent stroke and cardiovascular events. This exploratory analysis found no difference in the effect of statin treatment in reducing these events in subjects with or without type 2 diabetes or MetS. Trial Registration clinicaltrials.gov Identifier: NCT00147602.

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Published In

Arch Neurol

DOI

EISSN

1538-3687

Publication Date

October 2011

Volume

68

Issue

10

Start / End Page

1245 / 1251

Location

United States

Related Subject Headings

  • Young Adult
  • Triglycerides
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Pyrroles
  • Proportional Hazards Models
  • Neurology & Neurosurgery
  • Middle Aged
  • Metabolic Syndrome
 

Citation

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Callahan, A., Amarenco, P., Goldstein, L. B., Sillesen, H., Messig, M., Samsa, G. P., … SPARCL Investigators. (2011). Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Arch Neurol, 68(10), 1245–1251. https://doi.org/10.1001/archneurol.2011.146
Callahan, Alfred, Pierre Amarenco, Larry B. Goldstein, Henrik Sillesen, Mike Messig, Gregory P. Samsa, Irfan Altafullah, et al. “Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial.Arch Neurol 68, no. 10 (October 2011): 1245–51. https://doi.org/10.1001/archneurol.2011.146.
Callahan A, Amarenco P, Goldstein LB, Sillesen H, Messig M, Samsa GP, Altafullah I, Ledbetter LY, MacLeod MJ, Scott R, Hennerici M, Zivin JA, Welch KMA, SPARCL Investigators. Risk of stroke and cardiovascular events after ischemic stroke or transient ischemic attack in patients with type 2 diabetes or metabolic syndrome: secondary analysis of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial. Arch Neurol. 2011 Oct;68(10):1245–1251.

Published In

Arch Neurol

DOI

EISSN

1538-3687

Publication Date

October 2011

Volume

68

Issue

10

Start / End Page

1245 / 1251

Location

United States

Related Subject Headings

  • Young Adult
  • Triglycerides
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Pyrroles
  • Proportional Hazards Models
  • Neurology & Neurosurgery
  • Middle Aged
  • Metabolic Syndrome