Efecto del tratamiento intensivo con atorvastatina frente a dosis estándar de estatinas en el riesgo de ictus de pacientes con enfermedad coronaria previa. Metaanálisis de cinco ensayos aleatorizados con 25.709 pacientes

AIM: To evaluate the efficacy of intensive lipid lowering treatment with atorvastatin versus standard doses of statins (simvastatin, atorvastatin, lovastatin or pravastatin) on the risk of stroke, using meta-analytic techniques. PATIENTS AND METHODS: The meta-analysis included 5 randomized trials that met the inclusion criteria: comparison between intensive atorvastatin treatment (atorvastatin 80 mg or target LDL < 70 mg/dL) and standard doses of statins, with a clinical follow-up of more than 12 months and stroke as clinical endpoint. TNT (n = 9,917) atorvastatin 80 mg vs. 10 mg; IDEAL (n = 8,888) atorvastatin 80 mg vs. simvastatin 20-40 mg; PROVE-IT (n = 4,162) atorvastatin 80 mg vs. pravastatin 40 mg; ALLIANCE (n = 2,442) atorvastatin 80 mg or target LDL < 70 mg/dL vs. standard treatment; and VBBS (n = 300) atorvastatin 80 mg vs. low dose lavastatin. The selected studies included secondary prevention patients (acute coronary syndrome, stable coronary disease and patients eligible for angioplasty). 25,709 patients were included (12,910 allocated to intensive atorvastatin treatment, and 12,799 to standard doses of statins). Stroke incidence, as reported from each trial, was compared between both treatments. RESULTS: Out of the 25,709 patients, 713 (2.77%) suffered a stroke during follow-up. The incidence of stroke was significantly reduced with intensive atorvastatin treatment in comparison with conventional doses of statins: 2.52% (n = 325) vs. 3.03% (n = 388); relative risk = 0.83; 95% confidence interval = 0.72-0.96; p = 0.0121. CONCLUSIONS: Intensive lipid lowering treatment with atorvastatin is associated with a 17% relative risk reduction of stroke in comparison with conventional doses of statins in secondary prevention population.