Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?

  • Luis Castilla-GuerraEmail author
  • María del Carmen Fernandez-Moreno
  • David Leon-Jimenez
  • Miguel Angel Rico-Corral
Cerebrovascular Disorders (D Jamieson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cerebrovascular Disorders


Purpose of review

We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.

Recent findings

Recently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lowering medications: IMPROVE-IT with ezetimibe on top of simvastatin and PCSK9 inhibitors—FOURIER with evocolumab and ODYSSEY-OUTCOMES with alirocumab—on top of statin therapy.


LDL-cholesterol remains the primary lipid treatment target for reduction of stroke risk. Randomized trials have shown that each reduction of 40 mg/dL in the level of LDL-cholesterol reduces the stroke risk by approximately one quarter, and further, reductions in LDL-cholesterol levels have shown to produce additional reductions in stroke risk. Currently, we have evidence of benefit for adding non-statin lipid-modifying therapies to statins to reduce stroke risk. Surely, these novel strategies to reduce residual lipidic risk will provide future benefits on stroke prevention.


Cholesterol Ezetimibe PCSK9 inhibitors SPARCL trial Statins Stroke prevention 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Luis Castilla-Guerra
    • 1
    • 2
    Email author
  • María del Carmen Fernandez-Moreno
    • 2
    • 3
  • David Leon-Jimenez
    • 1
  • Miguel Angel Rico-Corral
    • 1
    • 2
  1. 1.Vascular Risk Unit, Department of Internal MedicineHospital Virgen MacarenaSevilleSpain
  2. 2.Associate Professor, Faculty of MedicineUniversity of SevilleSevilleSpain
  3. 3.Department of NeurologyHospital de ValmeSevilleSpain

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