Dear Dr. Roach: I take two Aggrenox daily, plus a baby aspirin every evening, because I had minor strokes about 20 years ago. Vasculitis was suspected, but never was definitively shown through tests. I had no other obvious risk factors.
A few years ago, my cholesterol started to creep up (my LDL went from 110 to 155), so I tried 10 mg daily of Lipitor for about a month. I had to stop because of debilitating pain.
After stopping, it took me almost a year to get back to normal.
My doctor has suggested that it may be worth trying a different statin because of its benefits for people who have had a stroke. I am concerned about this because of my previous Lipitor experience.
How much additional benefit is there to adding a statin to Aggrenox and baby aspirin? Can you cite any studies to support adding a statin?
Dear M.H.: The best answer to this question comes from the SPARCL study, published in 2006.
In this study, people with a history of stroke or TIA were randomized to a statin or a placebo (the statin in the study was 80 mg of atorvastatin, Lipitor). Eighty-seven percent of the study participants were taking antiplatelet medicines, such as aspirin or aspirin plus dipyridamole (Aggrenox).
In the study, subjects had LDL levels between 100 and 190. The results showed that about 13 percent of people in the placebo group had had a stroke in the five years of the study, compared with 11 percent in the atorvastatin group.
The study did not show an increase in the subgroup of strokes called hemorrhagic strokes, where there is bleeding in the brain, a finding that has been seen in other studies of statins.
The atorvastatin group also had fewer heart attacks (8.6 percent versus 5.2 percent) and all cardiovascular events (29 percent versus 22 percent).
For someone who has a history of stroke or TIA who could tolerate high-dose atorvastatin, I would recommend it, based on this trial.
For someone who couldn’t tolerate atorvastatin, I would consider pravastatin, based both on other trials and on the fact that people who do poorly on atorvastatin are more likely to do well on pravastatin because of its different metabolism.
I would be very cautious, however, in a person with a history of hemorrhagic stroke.
Email questions to ToYourGoodHealth@med.cornell.edu.