Amarenco P, Callahan A, Campese III VM, Goldstein LB, Hennerici MG, Messig M, et al. Effect of High-Dose Atorvastatin on Renal Function in Subjects With Stroke or Transient Ischemic Attack in the SPARCL Trial. Stroke. 2014
Chronic kidney disease (CKD) shares many risk factors with cerebrovascular disease – principally hypertension, diabetes, and dyslipidemia. Lowering low-density lipoprotein (LDL) cholesterol in patients with dyslipidemia and coronary artery disease or diabetes has been shown to be renoprotective in addition to reducing cardiovascular events. CKD has several implications for patients with cerebrovascular disease including conferring an increased risk for stroke and being an independent predictor of mortality and outcomes after stroke. Thus, CKD, which is also a global public health problem, should also be of interest to neurologists.
This study is consistent with prior reports suggestive of the idea that statin treatment is nephroprotective in high-risk patients with vascular disease. In the SPARCL patient population, an effect was seen within a year and is maintained for the 5 years of follow-up. Its important to note that the study cohort also had adequate blood pressure control and appropriate management of other vascular risk factors. Also, a small number of patients in this study had stage 4 or 5 CKD, so it is difficult to assess if 80mg atorvastatin treatment could benefit those with more severe renal dysfunction. Though the degree of improvement in GFR may seem modest, this is just another reason to use high intensity statin (atorvastatin) after non-cardioembolic stroke/TIA.
How do you get around this FDA recommendation?
FDA announces new safety recommendations for high-dose simvastatin.
The agency is recommending that simvastatin 80 mg be used only in patients who have been taking this dose for 12 months or more and have not experienced any muscle toxicity. It should not be prescribed to new patients.