BACKGROUND The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial compared atorvastatin 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 This post hoc analysis assessed 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 six 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 six 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.

中文翻译：

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在 SPARCL 试验中，阿托伐他汀可减少跨血管区域的首次和随后的血管事件

背景 积极降低胆固醇水平 (SPARCL) 试验在 4,731 名近期卒中或短暂性脑缺血发作且无已知冠心病的参与者中比较了阿托伐他汀与安慰剂。阿托伐他汀减少了卒中的首次发生和复合血管事件的首次发生。目的 这项事后分析评估了 SPARCL 中所有（首次和后续）血管事件的发生以及阿托伐他汀通过血管区域（脑血管、冠状动脉或外周）减少这些事件的效果。方法 通过边际比例风险模型总结总体和按血管区域对总判定血管事件的治疗效果。用累积发生率函数估计每个治疗组的血管事件发生率。结果 安慰剂组在 6 年内每 100 名参与者估计有 41.2 次首次血管事件和 62.7 次总血管事件。阿托伐他汀组首次发生血管事件减少 164 例，总血管事件减少 390 例（总事件风险比 0.68，95% 置信区间 0.60 至 0.77）。总事件减少包括脑血管事件减少 177 次，冠状动脉事件减少 170 次，外周事件减少 43 次。六年来，阿托伐他汀治疗可避免每 100 名参与者发生 20 起血管事件。结论 在近期发生中风或短暂性脑缺血发作的参与者中，使用阿托伐他汀预防的血管事件总数是首次预防事件数的两倍多。