Trial reportNeurology2008
Hemorrhagic stroke in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels study.
Trial report in Neurology, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06649240 (Optimal Target Low-density Lipoprotein Cholesterol Level for Small Vessel Occlusion Stroke), which is not on this map. Cited by 138 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Optimal Target Low-density Lipoprotein Cholesterol Level for Small Vessel Occlusion Stroke (SVO70)
Who cites it
138 citing papers in PubMed, 8 syntheses or guidelines pooled it, 404 citations in OpenAlex.
- Advances in statin adverse reactions and the potential mechanisms: A systematic review.Journal of advanced research · 2025Pooled it
- Low-Density Lipoprotein Cholesterol Reductions of not Less Than 60 mg/dL Prevent Hemorrhagic Stroke in Hypertensive Populations: A Meta-analysis.Reviews in cardiovascular medicine · 2025Pooled it
- 2018 Guidelines for the management of dyslipidemia.The Korean journal of internal medicine · 2019Guideline
- The 2018 Cholesterol Management Guidelines: Topics in Secondary ASCVD Prevention Clinicians Need to Know.Current atherosclerosis reports · 2019Guideline
- Statins for the prevention of stroke: a meta-analysis of randomized controlled trials.PloS one · 2014Pooled it
- Statin pretreatment may increase the risk of symptomatic intracranial haemorrhage in thrombolysis for ischemic stroke: results from a case-control study and a meta-analysis.Journal of neurology · 2012Pooled it
- Guideline
- The role of statins in neurosurgery.Neurosurgical review · 2010Pooled it
- Assessing the effectiveness of statin therapy for alleviating cerebral small vessel disease progression in people ≥75 years of age.BMC geriatrics · 2020Trial
- Different Influences of Statin Treatment in Preventing At-Risk Stroke Subtypes: A Post Hoc Analysis of J-STARS.Journal of atherosclerosis and thrombosis · 2020Trial
- Effect of Alirocumab on Stroke in ODYSSEY OUTCOMES.Circulation · 2019Trial
- Non-Achievement of Low-Density Lipoprotein Cholesterol Management Goals: Implications on High-Risk Cardiovascular Disease Patients Within the Japan Atherosclerosis Society 2022 Guideline Recommendations.Circulation reports · 2026Article
- Statin therapy and stroke risk in patients with hypercholesterolaemia: a population-based longitudinal study using electronic health records in South London.BMC medicine · 2026Article
- Lipid Management for Secondary Prevention in Atherosclerotic Cardiovascular Disease: A Scoping Review and Scientific Report.Journal of atherosclerosis and thrombosis · 2026Article
- Pleiotropic Effects of Statins: Focus on Endothelial Function, Plaque Stability and Thrombosis (Part II).Current atherosclerosis reports · 2026Review
- The Effect of Statins on Bleeding in Isolated Coronary Artery Bypass Grafting Statins in CABG.Journal of clinical medicine · 2025Article
- Secondary prevention using a statin with or without aspirin among Ghanaian intracerebral hemorrhage survivors: A feasibility randomized trial.Equity neuroscience · 2025Article
- Type 2 statin use increased perioperative blood loss in primary reverse total shoulder arthroplasty.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- Association Between Antihypertensive Treatment Discontinuation and the Development of Intracerebral Hemorrhage in Japanese Patients With Hypertension: The LIFE Study.Journal of the American Heart Association · 2025Article
- Patterns and predictors of statin therapy after ischemic stroke and TIA: insights from the LIPYDS multicenter study.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2025Observational
78 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
9 authors at 1 institution in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study, atorvastatin 80 mg/day reduced the risk of stroke in patients with recent stroke or TIA. Post hoc analysis found this overall benefit included an increase in the numbers of treated patients having hemorrhagic stroke (n = 55 for active treatment vs n = 33 for placebo).
methodsWe explored the relationships between hemorrhage risk and treatment, baseline patient characteristics, most recent blood pressure, and most recent low-density lipoprotein (LDL) cholesterol levels prior to the hemorrhage.
resultsOf 4,731 patients, 67% had ischemic strokes, 31% TIAs, and 2% hemorrhagic strokes as entry events. In addition to atorvastatin treatment (HR 1.68, 95% CI 1.09 to 2.59, p = 0.02), Cox multivariable regression including baseline variables significant in univariable analyses showed that hemorrhagic stroke risk was higher in those having a hemorrhagic stroke as the entry event (HR 5.65, 95% CI 2.82 to 11.30, p < 0.001), in men (HR 1.79, 95% CI 1.13 to 2.84, p = 0.01), and with age (10 y increments, HR 1.42, 95% CI 1.16 to 1.74, p = 0.001). There were no statistical interactions between these factors and treatment. Multivariable analyses also found that having Stage 2 (JNC-7) hypertension at the last study visit before a hemorrhagic stroke increased risk (HR 6.19, 95% CI 1.47 to 26.11, p = 0.01), but there was no effect of most recent LDL-cholesterol level in those treated with atorvastatin.
conclusionsHemorrhagic stroke was more frequent in those treated with atorvastatin, in those with a hemorrhagic stroke as an entry event, in men, and increased with age. Those with Stage 2 hypertension at the last visit prior to the hemorrhagic stroke were also at increased risk. Treatment did not disproportionately affect the hemorrhagic stroke risk associated with these other factors. There were no relationships between hemorrhage risk and baseline low-density lipoprotein (LDL) cholesterol level or recent LDL cholesterol level in treated patients.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.