Stroke prevention and statin treatment

Identifying patient perceptions and attitudes regarding statin-associated diabetes mellitus: a mixed-methods study

Aim: The aims of this study were to explore factors that influence initiation and continuation of statin therapy. Patients & methods: Mixed-method design employed with 73 patients completing surveys and 14 patients participating in semi-structured interviews. Results: When lower total cholesterol is achieved, patients' views are favorable while views of statin therapy diminish among those with higher total cholesterol values. All patients are concerned with adverse events including the potential for developing diabetes. However, overall patients believe the benefits of statins outweigh the risk of diabetes. Conclusion: Barriers remain that prevent patients from achieving cholesterol goals and maintaining or initiating statin therapy. Effective strategies to provide accurate information about the risks and benefits of statin therapy, and implementation of shared decision-making to improve medication adherence and persistence are needed.

Statin use before and after acute ischemic stroke onset improves neurological outcome

The devastating consequences of stroke, both in terms of morbidity and mortality, and the economic implications it has worldwide, coupled with a growing knowledge regarding its pathophysiology, has led to the development of novel therapeutic strategies in recent years that have had an enormous impact on clinical practice and the outcome of stroke patients. While thrombolysis is regarded as the most important of these developments, its relatively narrow therapeutic window and complexity of administration imply that only a minority of stroke patients can benefit from it. Among other strategies, in an attempt to overcome this limitation, research has focused on the development of neuroprotection aimed to salvage ischemic brain tissue by means complementary to reperfusion. Among these approaches, the use of statins stands out, which, by inhibiting the HMG CoA reductase, interfere with the formation of isoprenoid intermediates in the biosynthesis of cholesterol, and have been shown to have a positive impact in both the incidence and outcome of acute stroke. The main results of animal models, observational studies, clinical trials and opinion articles available in the medical literature covering the effect of statins on acute brain ischemia will be reviewed in order to provide in-depth information regarding their mode of action and current evidence regarding their potential benefits for ischemic stroke patients.

Biological consequences of statins in Candida species and possible implications for human health

The statins, simvastatin and atorvastatin are the most widely prescribed drugs. Statins lower cholesterol levels through their action on HMG-CoA (3-hydroxy-3-methylglutaryl-CoA) reductase, an essential enzyme for the biosynthesis of cholesterol. Fungal HMG-CoA reductases are also inhibited by statins, resulting in reduced levels of ergosterol (the fungal equivalent of cholesterol) and concomitant growth inhibition. This effect occurs in a range of fungal species and possibly affects fungal colonization of people on statin therapy. Furthermore, it may suggest that statins could have a role in new antifungal therapies. Possibly associated with the reduction in ergosterol levels, statins also inhibit respiratory growth. In the yeast, Candida glabrata, passage with statins dramatically increased the frequencies of petite mutants that were devoid of mitochondrial DNA, suggesting that statins caused a defect in the maintenance of mitochondrial DNA. These observations in C. glabrata may provide further insights into side effects of statins in humans undergoing treatment for hypercholesterolaemia. In addition, C. glabrata may be highly useful for the preliminary screening of agents to reduce statin side effects.

Role of HMG-CoA reductase inhibitors in neurological disorders : progress to date

Inhibitors of HMG-CoA reductase (statins) are cholesterol-lowering agents that dramatically reduce morbidity and mortality in patients with established cardiovascular disease. In addition, they exhibit pleiotropic effects that operate independently of lipid modification. Statin administration results in greater nitric oxide bioavailability, improved endothelial function, enhanced cerebral blood flow, immune modulation with anti-inflammatory action, decreased platelet aggregation and antioxidant activity. Some or all of these effects may improve outcome or ameliorate symptoms in neurological disorders. This article examines the potential role of statins in treating stroke, Alzheimer's disease, multiple sclerosis and Parkinson's disease. Studies are ongoing in this controversial area, but there are no firm conclusions. The appropriateness of initiating statin therapy for neurological disorders is not established at this time. The exception is stroke, in which recurrence is significantly reduced by statin therapy.