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Liu Q, He S, Lin Y, Tan S, Zhou J, Yang J. Prior statin use in acute ischemic stroke patients with mechanical thrombectomy: A prospective cohort study in China. Clin Neurol Neurosurg 2023; 234:107988. [PMID: 37769498 DOI: 10.1016/j.clineuro.2023.107988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 09/16/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) has been proven to be effective for selected patients with acute ischemic stroke (AIS). However, conflicting findings have suggested the association between prior statin use and outcomes in AIS patients with MT, with a particular lack of information in the Chinese population. Via a prospective cohort study, we explored the safety and efficacy of prior statin use in Chinese AIS patients with MT. METHODS We consecutively enrolled AIS patients treated with MT from the First Affiliated Hospital of Chengdu Medical College and Nanjing First Hospital between June 2015 and June 2022 who were under prior statin use or not. Safety and efficacy outcomes were prospectively followed. The primary outcomes were defined as 90-day favorable outcomes (mRS score 0-2). Secondary outcomes included successful recanalization (TICI≥2b), early neurological improvement (decrease of National Institutes of Health Stroke Scale (NIHSS) score ≥ 4 points at 24 h), symptomatic intracerebral hemorrhage (sICH), and death at 90 days. RESULTS We enrolled 334 patients in total, 50 of whom (15.0%) undertaken statins administration before AIS. 117 (35.0%) patients had favorable outcomes at 90 days, 288 (86.2%) patients had successful recanalization, 108 (32.3%) patients achieved early neurological improvement, 41 (12.3%) patients had sICH and 73 (21.9%) patients died within 90 days. The 90-day favorable outcomes were not significantly different (adjusted OR=0.853, 95% CI 0.449-1.620, P = 0.626) between prior statins use group and no statins use group. There was no significant difference in recanalization (adjusted OR=1.466, 95% CI 0.536-4.009, P = 0.456), early neurological improvement (adjusted OR=1.568, 95% CI 0.811-3.032, P = 0.181), sICH (adjusted OR=0.850, 95% CI 0.325-2.224, P = 0.741), ICH (adjusted OR=1.029, 95% CI 0.479-2.490, P = 0.942), and 90-day mortality (adjusted OR=0.381, 95% CI 0.091-1.586, P = 0.185) between the two groups. CONCLUSIONS Prior statin use may be safe for Chinese AIS patients with MT, but its efficacy warrants further research.
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Affiliation(s)
- Quan Liu
- Department of Emergency, Chengdu Second People's Hospital, Chengdu, China
| | - Song He
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Yapeng Lin
- Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Song Tan
- Department of Neurology, Sichuan Provincial People's Hospital, School of Medicine,University of Electronic Science and Technology of China, Chengdu, China
| | - Junshan Zhou
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Jie Yang
- Department of Neurology, Sichuan Provincial People's Hospital, School of Medicine,University of Electronic Science and Technology of China, Chengdu, China.
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Mele C, Maggioni G, Giordano A, Lunardon C, Balsamo F, Mazzone A, Pistarini C. A Retrospective Study on Statins and Post-stroke Patients: What About Functional Outcome and Follow-Up in a Stroke Rehabilitation Cohort? Front Neurol 2021; 12:744732. [PMID: 34744982 PMCID: PMC8567028 DOI: 10.3389/fneur.2021.744732] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/23/2021] [Indexed: 12/26/2022] Open
Abstract
Objective: Statins exert pleiotropic effects by influencing several mechanisms, including synaptogenesis, neurogenesis, cerebral flow regulation, and angiogenesis. Results from in vitro and animal models suggest that statins could have beneficial effect on functional recovery and outcome after stroke events. However, results in human studies are still controversial. The aim of our study was to evaluate the role of statin in influencing functional outcome and subsequent clinical follow-up in a large cohort of post-stroke rehabilitation patients. Methods: This retrospective study consecutively enrolled 413 adult patients with stroke event, admitted to the division of Neurorehabilitation of the IRCCS ICS Maugeri, Veruno (Italy), for an individual rehabilitation program between 2015 and 2017. Follow-up lasted 3–5 years after discharge. Demographic data, etiology, classification, and anatomical site of stroke lesion, functional assessment, use and duration of statin therapy, and death during hospitalization were collected at baseline and on discharge. Clinical data on subsequent follow-up were also evaluated, considering these as variables: stroke recurrence, bone fractures, cardiovascular complications, and death. Results: In our cohort, 177 patients (42.9%) were prescribed statin therapy, of whom 50 (28.2%) before the stroke event and 127 (71.8%) at the beginning of the rehabilitation process. The use and type of statin therapy as well as the duration of treatment were not associated with recovery and functional outcome, regardless of confounders including sex, age, etiology, and site of stroke lesion, and initial functional level. For what concern post-discharge clinical follow-up, the use of statin therapy was significantly associated with a lower risk of bone fractures (OR = 0.095, CI 95%: 0.012–0.743, p = 0.01) independently from age, sex, initial and final functional level, and comorbidities. Conclusions: The use of statins does not seem to influence the functional outcome in post-stroke patients. However, they could exert a protective role against bone fractures during post-discharge follow-up, suggesting further evaluation on this topic.
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Affiliation(s)
- Chiara Mele
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Maggioni
- Neurorehabilitation Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Andrea Giordano
- Bioengineering Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Clara Lunardon
- Neurorehabilitation Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Francesca Balsamo
- Neurorehabilitation Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Alessandra Mazzone
- Bioengineering Division, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Veruno, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Novara, Italy
| | - Caterina Pistarini
- Department of Physical and Rehabilitation Medicine, Istituti Clinici Scientifici Maugeri SPA SB, Institute of Genoa Nervi, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Genoa, Italy
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Treatment with Atorvastatin During Vascular Remodeling Promotes Pericyte-Mediated Blood-Brain Barrier Maturation Following Ischemic Stroke. Transl Stroke Res 2021; 12:905-922. [PMID: 33423214 DOI: 10.1007/s12975-020-00883-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/21/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
We previously showed that newly formed vessels in ischemic rat brain have high blood-brain barrier (BBB) permeability at 3 weeks after stroke due to a lack of major endothelial tight junction proteins (TJPs), which may exacerbate edema in stroke patients. Atorvastatin was suggested a dose-dependent pro-angiogenic effect and ameliorating BBB permeability beyond its cholesterol-lowering effects. This study examined our hypothesis that, during vascular remodeling after stroke, treatment with atorvastatin could facilitate BBB maturation in remodeling vasculature in ischemic brain. Adult spontaneously hypertensive rats underwent middle cerebral artery occlusion with reperfusion (MCAO/RP). Atorvastatin, at dose of 3 mg/kg, was delivered daily starting at 14 days after MCAO/RP onset for 7 days. The rats were studied at multiple time points up to 8 weeks with multimodal-MRI, behavior tests, immunohistochemistry, and biochemistry. The delayed treatment of atorvastatin significantly reduced infarct size and BBB permeability, restored cerebral blood flow, and improved the neurological outcome at 8 weeks after MCAO/RP. Postmortem studies showed that atorvastatin promoted angiogenesis and stabilized the newly formed vessels in peri-infarct areas. Importantly, atorvastatin facilitated maturation of BBB properties in the new vessels by promoting endothelial tight junction (TJ) formation. Further in vivo and in vitro studies demonstrated that proliferating peri-vascular pericytes expressing neural-glial antigen 2 (NG2) mediated the role of atorvastatin on BBB maturation through regulating endothelial TJ strand formations. Our results suggested a therapeutic potential of atorvastatin in facilitating a full BBB integrity and functional stroke recovery, and an essential role for pericyte-mediated endothelial TJ formation in remodeling vasculature.
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Yang Y, Torbey MT. Angiogenesis and Blood-Brain Barrier Permeability in Vascular Remodeling after Stroke. Curr Neuropharmacol 2020; 18:1250-1265. [PMID: 32691713 PMCID: PMC7770645 DOI: 10.2174/1570159x18666200720173316] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/27/2020] [Accepted: 07/11/2020] [Indexed: 11/22/2022] Open
Abstract
Angiogenesis, the growth of new blood vessels, is a natural defense mechanism helping to restore oxygen and nutrient supply to the affected brain tissue following an ischemic stroke. By stimulating vessel growth, angiogenesis may stabilize brain perfusion, thereby promoting neuronal survival, brain plasticity, and neurologic recovery. However, therapeutic angiogenesis after stroke faces challenges: new angiogenesis-induced vessels have a higher than normal permeability, and treatment to promote angiogenesis may exacerbate outcomes in stroke patients. The development of therapies requires elucidation of the precise cellular and molecular basis of the disease. Microenvironment homeostasis of the central nervous system is essential for its normal function and is maintained by the blood-brain barrier (BBB). Tight junction proteins (TJP) form the tight junction (TJ) between vascular endothelial cells (ECs) and play a key role in regulating the BBB permeability. We demonstrated that after stroke, new angiogenesis-induced vessels in peri-infarct areas have abnormally high BBB permeability due to a lack of major TJPs in ECs. Therefore, promoting TJ formation and BBB integrity in the new vessels coupled with speedy angiogenesis will provide a promising and safer treatment strategy for improving recovery from stroke. Pericyte is a central neurovascular unite component in vascular barriergenesis and are vital to BBB integrity. We found that pericytes also play a key role in stroke-induced angiogenesis and TJ formation in the newly formed vessels. Based on these findings, in this article, we focus on regulation aspects of the BBB functions and describe cellular and molecular special features of TJ formation with an emphasis on role of pericytes in BBB integrity during angiogenesis after stroke.
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Affiliation(s)
- Yi Yang
- Department of Neurology, University of New Mexico Health Sciences Center; Albuquerque, New Mexico, 87131, United States
| | - Michel T Torbey
- Department of Neurology, University of New Mexico Health Sciences Center; Albuquerque, New Mexico, 87131, United States
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Zhao W, Xiao ZJ, Zhao SP. The Benefits and Risks of Statin Therapy in Ischemic Stroke: A Review of the Literature. Neurol India 2020; 67:983-992. [PMID: 31512619 DOI: 10.4103/0028-3886.266274] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Statins are effective cholesterol-lowering drugs for reducing the risks of mortality and morbidity of cardiovascular diseases. Increasing evidence has shown that statin use is associated with a significant beneficial effect in patients with ischemic stroke. Both pre-stroke and post-stroke statin use has been found to be beneficial in ischemic stroke. Furthermore, good adherence is associated with a better clinical outcome, and statin withdrawal is associated with a poor functional outcome in patients with ischemic stroke. High-intensity statin therapy is advocated for the treatment of ischemic stroke. However, there are concerns regarding the adverse effects associated with statin use in ischemic stroke such as intracranial hemorrhage. In this review, we summarize the beneficial effect of statin use in ischemic stroke and discuss the potential risks associated with statin therapy.
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Affiliation(s)
- Wang Zhao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhi-Jie Xiao
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Shui-Ping Zhao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Lin HC, Lin JR, Tsai WC, Lu CH, Chang WN, Huang CC, Wang HC, Kung CT, Su CM, Su YJ, Lin WC, Cheng BC, Hsu CW, Lai YR, Tsai NW. The outcomes of statin therapy in patients with acute ischemic stroke in Taiwan: a nationwide epidemiologic study. QJM 2019; 112:891-899. [PMID: 31350560 DOI: 10.1093/qjmed/hcz189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/01/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Acute stroke is the third leading cause of death in Taiwan. Although statin therapy is widely recommended for stroke prevention, little is known about the epidemiology of statin therapy after acute ischemic stroke (AIS) in Taiwan. To investigate the effects of statin therapy on recurrent stroke, intracranial hemorrhage (ICH), coronary artery disease (CAD), cost of hospitalization and mortality, we conducted a nationwide population-based epidemiologic study. METHODS Cases of AIS were identified from the annual hospitalization discharge diagnoses of the National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision codes from January 2001 to December 2010. We divided the AIS patients into three groups: non-statin, pre-stroke statin and post-stroke statin. RESULTS A total of 422 671 patients with AIS (including 365 419 cases in the non-statin group, 22 716 cases in the pre-stroke statin group and 34 536 cases in the post-stroke statin group) were identified. When compared to the non-statin group, both statin groups had a lower recurrent stroke risk [pre-stroke statin: odds ratio (OR) = 0.84; 95% confidence interval (CI) = 0.82-0.87; P < 0.0001; post-stroke statin: OR = 0.89; 95% CI = 0.86-0.91; P < 0.0001], lower ICH risk (pre-statin: OR = 0.75; 95% CI = 0.69-0.82; P < 0.0001; post-stroke statin: OR = 0.75; 95% CI = 0.71-0.81; P < 0.0001), and a lower mortality rate (pre-stroke statin: OR = 0.56; 95% CI = 0.53-0.59; P < 0.0001; post-stroke statin: OR = 0.51; 95% CI = 0.48-0.53; P < 0.0001). In terms of CAD, only the post-statin group had a lower risk (OR = 0.81; 95% CI = 0.79-0.84; P < 0.0001) than the non-statin group. The post-statin group had the lowest 1-year medical costs after index discharge among the three groups. CONCLUSIONS Statin therapy reduced the risks of recurrent stroke, CAD, ICH and the first year mortality in patients after AIS. Treatment with statin therapy after AIS is a cost-effective strategy in Taiwan.
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Affiliation(s)
- H-C Lin
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - J-R Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
- Research Services Center for Health Information, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, Taiwan
| | - W-C Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - C-H Lu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, No. 70, Lianhai Rd., Gushan Dist., Kaohsiung City, Taiwan
| | - W-N Chang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - C-C Huang
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - H-C Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - C-T Kung
- Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - C-M Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - Y-J Su
- Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - W-C Lin
- Department of Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - B-C Cheng
- Department of Biological Science, National Sun Yat-Sen University, No. 70, Lianhai Rd., Gushan Dist., Kaohsiung City, Taiwan
- Department of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
| | - C-W Hsu
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, No. 70, Lianhai Rd., Gushan Dist., Kaohsiung City, Taiwan
| | - Y-R Lai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
- Department of Biological Science, National Sun Yat-Sen University, No. 70, Lianhai Rd., Gushan Dist., Kaohsiung City, Taiwan
| | - N-W Tsai
- Department of Neurology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, No. 123, Dapi Rd., Niaosong Dist., Kaohsiung City, Taiwan
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Davies JT, Delfino SF, Feinberg CE, Johnson MF, Nappi VL, Olinger JT, Schwab AP, Swanson HI. Current and Emerging Uses of Statins in Clinical Therapeutics: A Review. Lipid Insights 2016; 9:13-29. [PMID: 27867302 PMCID: PMC5110224 DOI: 10.4137/lpi.s37450] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/20/2016] [Accepted: 10/06/2016] [Indexed: 02/06/2023] Open
Abstract
Statins, a class of cholesterol-lowering medications that inhibit 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, are commonly administered to treat atherosclerotic cardiovascular disease. Statin use may expand considerably given its potential for treating an array of cholesterol-independent diseases. However, the lack of conclusive evidence supporting these emerging therapeutic uses of statins brings to the fore a number of unanswered questions including uncertainties regarding patient-to-patient variability in response to statins, the most appropriate statin to be used for the desired effect, and the efficacy of statins in treating cholesterol-independent diseases. In this review, the adverse effects, costs, and drug–drug and drug–food interactions associated with statin use are presented. Furthermore, we discuss the pleiotropic effects associated with statins with regard to the onset and progression of autoimmune and inflammatory diseases, cancer, neurodegenerative disorders, strokes, bacterial infections, and human immunodeficiency virus. Understanding these issues will improve the prognosis of patients who are administered statins and potentially expand our ability to treat a wide variety of diseases.
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Affiliation(s)
- Jonathan T Davies
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Spencer F Delfino
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Chad E Feinberg
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Meghan F Johnson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Veronica L Nappi
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Joshua T Olinger
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Anthony P Schwab
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
| | - Hollie I Swanson
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, USA
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Tuttolomondo A, Di Raimondo D, Pecoraro R, Maida C, Arnao V, Della Corte V, Simonetta I, Corpora F, Di Bona D, Maugeri R, Iacopino DG, Pinto A. Early High-dosage Atorvastatin Treatment Improved Serum Immune-inflammatory Markers and Functional Outcome in Acute Ischemic Strokes Classified as Large Artery Atherosclerotic Stroke: A Randomized Trial. Medicine (Baltimore) 2016; 95:e3186. [PMID: 27043681 PMCID: PMC4998542 DOI: 10.1097/md.0000000000003186] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 01/09/2023] Open
Abstract
Statins have beneficial effects on cerebral circulation and brain parenchyma during ischemic stroke and reperfusion. The primary hypothesis of this randomized parallel trial was that treatment with 80 mg/day of atorvastatin administered early at admission after acute atherosclerotic ischemic stroke could reduce serum levels of markers of immune-inflammatory activation of the acute phase and that this immune-inflammatory modulation could have a possible effect on prognosis of ischemic stroke evaluated by some outcome indicators. We enrolled 42 patients with acute ischemic stroke classified as large arteries atherosclerosis stroke (LAAS) randomly assigned in a randomized parallel trial to the following groups: Group A, 22 patients treated with atorvastatin 80 mg (once-daily) from admission day until discharge; Group B, 20 patients not treated with atorvastatin 80 mg until discharge, and after discharge, treatment with atorvastatin has been started. At 72 hours and at 7 days after acute ischemic stroke, subjects of group A showed significantly lower plasma levels of tumor necrosis factor-α, interleukin (IL)-6, vascular cell adhesion molecule-1, whereas no significant difference with regard to plasma levels of IL-10, E-Selectin, and P-Selectin was observed between the 2 groups. At 72 hours and 7 days after admission, stroke patients treated with atorvastatin 80 mg in comparison with stroke subjects not treated with atorvastatin showed a significantly lower mean National Institutes of Health Stroke Scale and modified Rankin scores. Our findings provide the first evidence that atorvastatin acutely administered immediately after an atherosclerotic ischemic stroke exerts a lowering effect on immune-inflammatory activation of the acute phase of stroke and that its early use is associated to a better functional and prognostic profile.
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Affiliation(s)
- Antonino Tuttolomondo
- From the Internal Medicine and Cardioangiology Ward (AT, DDR, RP, CM, VDC, IS, FC, AP), Dipartimento Biomedico di Medicina Interna e Specialistica; Department of Experimental Medicine and Clinical Neurosciences (VA), Clinical Neurology ward; Department of Experimental Medicine and Clinical Neurosciences (RM, DGI), Neurosurgical Section, University of Palermo; and School and Chair of Allergology, Dipartimento delle Emergenze e Trapianti d'Organo (DDB), University of Bari, Bari Italy
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Hong KS, Lee JS. Statins in Acute Ischemic Stroke: A Systematic Review. J Stroke 2015; 17:282-301. [PMID: 26437994 PMCID: PMC4635713 DOI: 10.5853/jos.2015.17.3.282] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/02/2015] [Accepted: 04/04/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Statins have pleiotropic effects of potential neuroprotection. However, because of lack of large randomized clinical trials, current guidelines do not provide specific recommendations on statin initiation in acute ischemic stroke (AIS). The current study aims to systematically review the statin effect in AIS. METHODS From literature review, we identified articles exploring prestroke and immediate post-stroke statin effect on imaging surrogate markers, initial stroke severity, functional outcome, and short-term mortality in human AIS. We summarized descriptive overview. In addition, for subjects with available data from publications, we conducted meta-analysis to provide pooled estimates. RESULTS In total, we identified 70 relevant articles including 6 meta-analyses. Surrogate imaging marker studies suggested that statin might enhance collaterals and reperfusion. Our updated meta-analysis indicated that prestroke statin use was associated with milder initial stroke severity (odds ratio [OR] [95% confidence interval], 1.24 [1.05-1.48]; P=0.013), good functional outcome (1.50 [1.29-1.75]; P<0.001), and lower mortality (0.42 [0.21-0.82]; P=0.0108). In-hospital statin use was associated with good functional outcome (1.31 [1.12-1.53]; P=0.001), and lower mortality (0.41 [0.29-0.58]; P<0.001). In contrast, statin withdrawal was associated with poor functional outcome (1.83 [1.01-3.30]; P=0.045). In patients treated with thrombolysis, statin was associated with good functional outcome (1.44 [1.10-1.89]; P=0.001), despite an increased risk of symptomatic hemorrhagic transformation (1.63 [1.04-2.56]; P=0.035). CONCLUSIONS The current study findings support the use of statin in AIS. However, the findings were mostly driven by observational studies at risk of bias, and thereby large randomized clinical trials would provide confirmatory evidence.
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Affiliation(s)
- Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
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Song B, Wang Y, Zhao X, Liu L, Wang C, Wang A, Du W, Wang Y, Xu Y. Inpatient Statin Use Is Associated with Decreased Mortality of Acute Stroke Patients with Very Low Low-Density Lipoprotein Cholesterol. J Stroke Cerebrovasc Dis 2015; 24:2369-74. [PMID: 26303789 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 06/15/2015] [Accepted: 06/24/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND To investigate the potential benefits of inpatient statin therapy on mortality of acute stroke patients with very low admission low-density lipoprotein cholesterol (LDL-C) level (<1.81 mmol/L). METHODS The acute stroke patients with admission LDL-C level less than 1.81 mmol/L were enrolled from the China National Stroke Registry. The patients were divided into statin group and non-statin group during hospitalization. The association between statin therapy and mortality of participants in 1 year was analyzed by multivariable binary logistic regression models. RESULTS A total of 1018 patients were enrolled, and the cumulative mortality rate was 10.1% at 3 months, 13.1% at 6 months, and 15.9 % at 1 year. The all-cause mortality rate in statin group was significantly lower than that in non-statin group (3.6% versus 13.7% at 3 months, P < .001; 6.2% versus 16.9% at 6 months, P < .001; 8.4% versus 20% at 1 year, P < .001). The logistic analyses showed that statin therapy during hospitalization was independently associated with decreased mortality at 3 months (odds ratio [OR], .35; 95% confidence interval [CI], .18-.67), at 6 months (OR, .42; 95% CI, .25-.73) and at 1 year (OR, .47; 95% CI, .29-.76). CONCLUSIONS Statin use during hospitalization could decrease mortality of acute ischemic stroke patients with very low admission LDL-C.
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Affiliation(s)
- Bo Song
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yuming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Choi JC, Lee JS, Park TH, Cho YJ, Park JM, Kang K, Lee KB, Lee SJ, Ko Y, Lee J, Kim JT, Yu KH, Lee BC, Cha JK, Kim DH, Lee J, Kim DE, Jang MS, Kim BJ, Han MK, Bae HJ, Hong KS. Effect of pre-stroke statin use on stroke severity and early functional recovery: a retrospective cohort study. BMC Neurol 2015. [PMID: 26224123 PMCID: PMC4520077 DOI: 10.1186/s12883-015-0376-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Experimental studies suggest that pre-stroke statin treatment has a dual effect of neuroprotection during ischemia and neurorestoration after ischemic injury. The aim of this study was to evaluate the effect of pre-stroke statin use on initial stroke severity and early clinical outcome. METHODS We used a prospective database enrolling patients with acute ischemic stroke from 12 hospitals in Korea between April 2008 and January 2012. Primary endpoint was the initial stroke severity as measured by the National Institutes of Health Stroke Scale (NIHSS) score. Secondary endpoints were good outcome (modified Rankin Scale [mRS], 0-2) and overall mRS distribution at discharge. Multivariable regression model and propensity score (PS) matching were used for statistical analyses. RESULTS Among the 8340 patients included in this study, 964 patients (11.6%) were pre-stroke statin users. The initial NIHSS score (mean [95% CI]) was lower among pre-stroke statin users vs. non-users in multivariable analysis (5.7 [5.2-6.3] versus 6.4 [5.9-6.9], p = 0.002) and PS analysis (5.2 [4.7-5.7] versus 5.7 [5.4-6.0], p = 0.043). Pre-stroke statin use was associated with increased achievement of mRS 0-2 outcome (multivariable analysis: OR [95% CI], 1.55 [1.25-1.92], p < 0.001; PS matching: OR [95% CI], 1.47 [1.16-1.88]; p = 0.002) and favorable shift on the overall mRS distribution (multivariable analysis: OR [95% CI], 1.29 [1.12-1.51], p = 0.001; PS matching: OR [95% CI], 1.31 [1.11-1.54]; p = 0.001). CONCLUSIONS Pre-stroke statin use was independently associated with lesser stroke severity at presentation and better early functional recovery in patients with acute ischemic stroke.
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Affiliation(s)
- Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Jeju National University, Jeju, South Korea.
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, South Korea.
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Seoul, South Korea.
| | - Yong-Jin Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea.
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, South Korea.
| | - Kyusik Kang
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, South Korea.
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University College of Medicine, Seoul, South Korea.
| | - Soo-Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea.
| | - Youngchai Ko
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea.
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, South Korea.
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea.
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea.
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, South Korea.
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea.
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, South Korea.
| | - Myung Suk Jang
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Moon-Ku Han
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Goyang, South Korea.
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Moonis M, Kumar R, Henninger N, Kane K, Fisher M. Pre and Post-stroke Use of Statins Improves Stroke Outcome. Indian J Community Med 2014; 39:214-7. [PMID: 25364144 PMCID: PMC4215501 DOI: 10.4103/0970-0218.143021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction: Although there is sufficient evidence that HMG CoA Reductase Inhibitors reduce stroke recurrence in patients with or ischemic heart disease, it remains unclear whether they also improve outcomes given before or after stroke onset and whether such an effect is more robust with pre-stroke or post-stroke use of statins. Materials and Methods: We carried out a retrospective analysis of a large University Health Consortium Database. Patients with statin use before or after stroke onset were included in the analysis. Twenty patients discontinued statins after stroke onset. The outcome measures were discharge home or long-term care facility and/or death within 45 days. Results: Patients with prior statin use were more likely to be discharged home (1.67, CI 1.12-2.49), as were post stroke statin patients who had a more robust effect OR 2.63, CI 1.61-4.53). Conclusions: Patients started on statins after stroke were more likely to be discharged home versus patients already on statins before stroke onset. However, both groups were also more likely to be discharged home than those patients not on statins.
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Affiliation(s)
- Majaz Moonis
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Rajat Kumar
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Nils Henninger
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Kevin Kane
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
| | - Marc Fisher
- Department of Neurology, University of Massachusetts Memorial Medical Center, Worcester, Massachusetts, USA
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13
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Al-Khaled M, Matthis C, Eggers J. Statin treatment in patients with acute ischemic stroke. Int J Stroke 2014; 9:597-601. [PMID: 24593194 DOI: 10.1111/ijs.12256] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 12/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the association of statin treatment with outcomes in patients with acute ischemic stroke. METHODS Over a 4.5-year period (starting November 2007), 12 781 patients (mean age, 72·8 ± 12·6 years; 48·6% women) with acute ischemic stroke from 15 hospitals in Schleswig-Holstein, Germany, were enrolled in a population-based study and prospectively evaluated. The primary outcomes were the mortality during hospitalization and the disability (modified Rankin Scale score ≥2) at discharge from hospital. The secondary outcomes were the mortality and disability at three-months after discharge. RESULTS A total of 7535 patients (59%) with acute ischemic stroke were treated with statins. During hospitalization (mean, nine-days), the in-hospital mortality rate (4·7%; 95% confidence interval, 4·3-5·1%) was lower in patients treated with statins than in those without statins (2·3% vs. 7·9%, respectively; P < 0·001). At three-months after discharge, the mortality rate (6·9%; 95% confidence interval, 6·4-7·5%) was lower in patients treated with statins than in those without statins (5·0% vs. 10·6%, respectively; P < 0·001). Adjusted logistic regression analysis showed that statin treatment was associated with reduced rates of in-hospital mortality (odds ratio, 0·39; 95% confidence interval, 0·31-0·48; P < 0·001) and three-month mortality (odds ratio, 0.47; 95% confidence interval, 0·34-0·63; P < 0·001). A comparison of the patient groups revealed that patients on statins were likely to have lower disability rates at discharge (59% vs. 67%, respectively; P < 0·001) and after three-months (33% vs. 42%, respectively; P < 0·001) in patients who had survived the stroke. CONCLUSION Statin treatment may improve the outcomes in patients with acute ischemic stroke. Further studies are necessary to confirm this finding.
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14
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Song B, Wang Y, Zhao X, Liu L, Wang C, Wang A, Du W, Wang Y. Association between statin use and short-term outcome based on severity of ischemic stroke: a cohort study. PLoS One 2014; 9:e84389. [PMID: 24465409 PMCID: PMC3897364 DOI: 10.1371/journal.pone.0084389] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 11/14/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Statins reportedly improve clinical outcomes for ischemic stroke patients. However, it is unclear whether the contribution of statin treatment varies depending on the severity of stroke. We sought to investigate the relationship between statin use and the outcome of acute first-ever ischemic stroke patients stratified by stroke severity. METHODS A total of 7,455 acute first-ever ischemic stroke patients without statin treatment before onset were eligible from the China National Stroke Registry. A National Institutes of Health Stroke Scale (NIHSS) score of 0 to 4 was defined as minor stroke, and a NIHSS score of >4 was defined as non-minor stroke. We analyzed the association between statin use during hospitalization and mortality as well as functional outcome (measured by a modified Rankin Scale score of 0-5) at 3 months after onset using multivariable logistic regression models. RESULTS A total of 3,231 (43.3%) patients received statin treatment during hospitalization. Multivariable analysis showed that statin use during hospitalization decreased mortality of ischemic stroke patients (OR, 0.51; 95%CI, 0.38-0.67), but did not improve poor functional outcomes (OR, 0.95; 95CI%, 0.81-1.11) at 3 months. The interaction between statin use and stroke severity was significant both in dependence and death outcome (P = 0.04 for dependence outcome, P = 0.03 for death outcome). After stratification by stroke severity, statin use during hospitalization decreased the mortality of stroke (OR, 0.44; 95%CI, 0.31-0.62) and poor functional outcome (OR, 0.73; 95%CI, 0.57-0.92) at 3 months in the non-minor stroke group. CONCLUSIONS Statin use during hospitalization may improve the clinical outcome of acute first-ever ischemic stroke depending on the severity of stroke. Non-minor stroke patients may obtain benefit from statin treatment with improvements in poor functional outcomes and mortality.
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Affiliation(s)
- Bo Song
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- * E-mail:
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wanliang Du
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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15
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Mohebbi N, Khoshnevisan A, Naderi S, Abdollahzade S, Salamzadeh J, Javadi M, Mojtahedzadeh M, Gholami K. Effects of atorvastatin on plasma matrix metalloproteinase-9 concentration after glial tumor resection; a randomized, double blind, placebo controlled trial. ACTA ACUST UNITED AC 2014; 22:10. [PMID: 24397933 PMCID: PMC3896688 DOI: 10.1186/2008-2231-22-10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 10/06/2013] [Indexed: 11/10/2022]
Abstract
Background Neurosurgical procedures such as craniotomy and brain tumor resection could potentially lead to unavoidable cerebral injuries. Matrix metalloproteinase-9 (MMP-9) is up-regulated in neurological injuries. Statins have been suggested to reduce MMP- 9 level and lead to neuroprotection. Atorvastatin preoperatively administered to evaluate its neuroprotective effects and outcome assessment in neurosurgical-induced brain injuries after glial tumor resection. In this prospective, randomized, double-blind, placebo-controlled trial, 42 patients undergoing glial tumor surgery randomly received 40 mg atorvastatin or placebo twice daily from seven days prior to operation and continued for a 3 weeks period. Plasma MMP-9 concentration measured 4 times, immediately before starting atorvastatin or placebo, immediately before surgery, 24 hours and two weeks after the surgery. Karnofsky performance score was assessed before first dose of atorvastatin as a baseline and 2 months after the surgery. Results Karnofsky performance scale after surgery raised significantly more in Atorvastatin group (11.43 +/- 10.62 vs. 4.00 +/- 8.21) (p = 0.03). Atorvastatin did not significantly reduce MMP-9 plasma concentration 24 hours after surgery in comparison to placebo. No statistical significance detected regarding length of hospital stay among the groups. Significant reduction in MMP-9 plasma concentration was recorded in atorvastatin group two weeks after surgery (p = 0.048). Conclusions Significant statistical differences detected with atorvastatin group regarding MMP-9 plasma concentration, clinical outcome and Karnofsky performance score. Consequently, atorvastatin use may lead to better outcome after neurosurgical procedures.
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Affiliation(s)
| | | | | | | | | | | | | | - Kheirollah Gholami
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Ní Chróinín D, Asplund K, Åsberg S, Callaly E, Cuadrado-Godia E, Díez-Tejedor E, Di Napoli M, Engelter ST, Furie KL, Giannopoulos S, Gotto AM, Hannon N, Jonsson F, Kapral MK, Martí-Fàbregas J, Martínez-Sánchez P, Milionis HJ, Montaner J, Muscari A, Pikija S, Probstfield J, Rost NS, Thrift AG, Vemmos K, Kelly PJ. Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials. Stroke 2013; 44:448-56. [PMID: 23287777 DOI: 10.1161/strokeaha.112.668277] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤ 72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSIONS In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.
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Affiliation(s)
- Danielle Ní Chróinín
- Neurovascular Unit for Applied Translational Research and Therapeutics, Mater University Hospital/Dublin Academic Medical Centre, University College Dublin, Ireland.
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Flint AC, Kamel H, Navi BB, Rao VA, Faigeles BS, Conell C, Klingman JG, Sidney S, Hills NK, Sorel M, Cullen SP, Johnston SC. Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival. Stroke 2011; 43:147-54. [PMID: 22020026 DOI: 10.1161/strokeaha.111.627729] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Statins reduce infarct size in animal models of stroke and have been hypothesized to improve clinical outcomes after ischemic stroke. We examined the relationship between statin use before and during stroke hospitalization and poststroke survival. METHODS We analyzed records from 12 689 patients admitted with ischemic stroke to any of 17 hospitals in a large integrated healthcare delivery system between January 2000 and December 2007. We used multivariable survival analysis and grouped-treatment analysis, an instrumental variable method that uses treatment differences between facilities to avoid individual patient-level confounding. RESULTS Statin use before ischemic stroke hospitalization was associated with improved survival (hazard ratio, 0.85; 95% CI, 0.79-0.93; P<0.001), and use before and during hospitalization was associated with better rates of survival (hazard ratio, 0.59; 95% CI, 0.53-0.65; P<0.001). Patients taking a statin before their stroke who underwent statin withdrawal in the hospital had a substantially greater risk of death (hazard ratio, 2.5; 95% CI, 2.1-2.9; P<0.001). The benefit was greater for high-dose (>60 mg/day) statin use (hazard ratio, 0.43; 95% CI, 0.34-0.53; P<0.001) than for lower dose (<60 mg/day) statin use (hazard ratio, 0.60; 95% CI, 0.54-0.67; P<0.001; test for trend P<0.001), and earlier treatment in-hospital further improved survival. Grouped-treatment analysis showed that the association between statin use and survival cannot be explained by patient-level confounding. CONCLUSIONS Statin use early in stroke hospitalization is strongly associated with improved poststroke survival, and statin withdrawal in the hospital, even for a brief period, is associated with worsened survival.
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Affiliation(s)
- Alexander C Flint
- Department of Neuroscience, Kaiser Permanente, Redwood City, CA 94063, USA.
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Al Harbi SA, Tamim HM, Arabi YM. Association between statin therapy and outcomes in critically ill patients: a nested cohort study. BMC CLINICAL PHARMACOLOGY 2011; 11:12. [PMID: 21819615 PMCID: PMC3199769 DOI: 10.1186/1472-6904-11-12] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 08/06/2011] [Indexed: 12/21/2022]
Abstract
Background The effect of statin therapy on mortality in critically ill patients is controversial, with some studies suggesting a benefit and others suggesting no benefit or even potential harm. The objective of this study was to evaluate the association between statin therapy during intensive care unit (ICU) admission and all-cause mortality in critically ill patients. Methods This was a nested cohort study within two randomised controlled trials conducted in a tertiary care ICU. All 763 patients who participated in the two trials were included in this study. Of these, 107 patients (14%) received statins during their ICU stay. The primary endpoint was all-cause ICU and hospital mortality. Secondary endpoints included the development of sepsis and severe sepsis during the ICU stay, the ICU length of stay, the hospital length of stay, and the duration of mechanical ventilation. Multivariate logistic regression was used to adjust for clinically and statistically relevant variables. Results Statin therapy was associated with a reduction in hospital mortality (adjusted odds ratio [aOR] = 0.60, 95% confidence interval [CI] 0.36-0.99). Statin therapy was associated with lower hospital mortality in the following groups: patients >58 years of age (aOR = 0.58, 95% CI 0.35-0.97), those with an acute physiology and chronic health evaluation (APACHE II) score >22 (aOR = 0.54, 95% CI 0.31-0.96), diabetic patients (aOR = 0.52, 95% CI 0.30-0.90), patients on vasopressor therapy (aOR = 0.53, 95% CI 0.29-0.97), those admitted with severe sepsis (aOR = 0.22, 95% CI 0.07-0.66), patients with creatinine ≤100 μmol/L (aOR = 0.14, 95% CI 0.04-0.51), and patients with GCS ≤9 (aOR = 0.34, 95% CI 0.17-0.71). When stratified by statin dose, the mortality reduction was mainly observed with statin equipotent doses ≥40 mg of simvastatin (aOR = 0.53, 95% CI 0.28-1.00). Mortality reduction was observed with simvastatin (aOR = 0.37, 95% CI 0.17-0.81) but not with atorvastatin (aOR = 0.80, 95% CI 0.84-1.46). Statin therapy was not associated with a difference in any of the secondary outcomes. Conclusion Statin therapy during ICU stay was associated with a reduction in all-cause hospital mortality. This association was especially noted in high-risk subgroups. This potential benefit needs to be validated in a randomised, controlled trial.
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Affiliation(s)
- Shmeylan A Al Harbi
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Ní Chróinín D, Callaly EL, Duggan J, Merwick Á, Hannon N, Sheehan Ó, Marnane M, Horgan G, Williams EB, Harris D, Kyne L, McCormack PM, Moroney J, Grant T, Williams D, Daly L, Kelly PJ. Association Between Acute Statin Therapy, Survival, and Improved Functional Outcome After Ischemic Stroke. Stroke 2011; 42:1021-9. [DOI: 10.1161/strokeaha.110.596734] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Danielle Ní Chróinín
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Elizabeth L. Callaly
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Joseph Duggan
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Áine Merwick
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Niamh Hannon
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Órla Sheehan
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Michael Marnane
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Gillian Horgan
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Emma B. Williams
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Dawn Harris
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Lorraine Kyne
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Patricia M.E. McCormack
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Joan Moroney
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Tim Grant
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - David Williams
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Leslie Daly
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
| | - Peter J. Kelly
- From the Neurovascular Clinical Science Unit (D.N.C., J.D., A.M., N.H., O.S., M.M., G.H., E.B.W., D.H., L.K., P.J.K.), Mater Misericordiae University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland; Connolly Hospital (E.L.C., P.M.EM.), Dublin, Ireland; Beaumont Hospital (J.M., D.W.), Dublin, Ireland; Centre for Support and Training in Analysis and Research (T.G., L.D.), School of Public Health, Physiotherapy & Population Science, University College Dublin,
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Rhoney DH. Contemporary Management of Transient Ischemic Attack: Role of the Pharmacist. Pharmacotherapy 2011; 31:193-213. [DOI: 10.1592/phco.31.2.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Previous statins treatment and risk of post-stroke infections. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Previous statins treatment and risk of post-stroke infections. Neurologia 2010; 26:150-6. [PMID: 21163226 DOI: 10.1016/j.nrl.2010.07.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2010] [Revised: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Clinical and laboratory studies have attributed an inmuno-supressor effect to the statins. Furthermore, the administration of simvastatin in the acute onset of stroke has been associated with an increased infection frequency. Our objective is to assess the influence of statins previous treatment on infection after ischemic stroke. PATIENTS AND METHODS Observational study of patients with ischaemic stroke hospitalised in a Stroke Unit. Demographic data, vascular risk factors, stroke severity, stroke subtype and previous statins treatment were evaluated. The following infections were registered: pneumonia, urinary tract infection, pseudomembranous colitis and sepsis. The patients were classified into two groups, depending on previous statin treatment. RESULTS A total of 2045 patients were included (1165 were male, aged 69.05±12.5 years). Of these, 306 (15%) patients were receiving statins prior to stroke. These patients had more frequently arterial hypertension, DM, peripheral arterial disease and hypercholesterolaemia than the patients who were not treated with statins (P<0001). There was no statistically significant difference between overall in-hospital infection frequency between patients treated with statins and those with no statins treatment, (11.8% vs. 13%), nor in individual infection type: pneumonia (7.8% vs. 10.2%), urinary tract infection (4.2% vs. 2.8%), pseudomembranous colitis (0.3% vs. 0.7%) and sepsis (2.6% vs. 4.4%). In the atherothrombotic stroke subtype, statins were associated with a lower frequency of sepsis (unadjusted OR, 0.949; 95% CI; 0.928-0.971). CONCLUSIONS Previous treatment with statins does not appear to influence the frequency of in-hospital infections in patients with ischaemic stroke.
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Ruiz-Bailén M, Pérez-Valenzuela J, Ferrezuelo-Mata A, Obra-Cuadra RJ. [Effect of the administration of statins in non-cardiac critical disease]. Med Intensiva 2010; 35:107-16. [PMID: 20630621 DOI: 10.1016/j.medin.2010.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 05/28/2010] [Accepted: 05/31/2010] [Indexed: 12/18/2022]
Abstract
Administration of statins has been shown to be effective in reducing cardiovascular mortality. Their benefit could expand towards other areas of intensive medicine, it being possible to decrease mortality of the critically ill patient. There are several studies, although without a high level of evidence, that have detected a possible benefit when they are administered as well as clinical deterioration when they are discontinued, compared to those patients who had previously taken them. Even though most of the patients who had previously taken statins did so as primary or secondary prevention, thus having greater comorbidity, overall, a decrease is detected in the mortality of these subgroups. This benefit could be generalized to all the critical conditions, although studies with a higher level of evidence are needed for their adequate comparison.
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Affiliation(s)
- M Ruiz-Bailén
- Departamento de Ciencias de la Salud, Universidad de Jaén, Jaén, Spain.
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Huisa BN, Stemer AB, Zivin JA. Atorvastatin in stroke: a review of SPARCL and subgroup analysis. Vasc Health Risk Manag 2010; 6:229-36. [PMID: 20407630 PMCID: PMC2856578 DOI: 10.2147/vhrm.s6795] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Indexed: 01/15/2023] Open
Abstract
Statin therapy in patients with cardiovascular disease is associated with reduced incidence of stroke. The Stroke Prevention by Aggressive Reduction of Cholesterol Levels (SPARCL) trial showed daily treatment with 80 mg of atorvastatin in patients with a recent stroke or transient ischemic attack (TIA) reduced the incidence of fatal or nonfatal stroke by 16%. Several post hoc analyses of different subgroups followed the SPARCL study. They have not revealed any significant differences when patients were sorted by age, sex, presence of carotid disease or type of stroke, with the exception of intracranial hemorrhage as the entry event. Lower low-density lipoprotein cholesterol levels in addition to possible neuroprotective mechanisms due to atorvastatin treatment correlate with improved risk reduction. Although not predefined subgroups and subject to an insufficient power, these post hoc studies have generated new clinical questions. However, clinicians should avoid denying therapy based on such subgroup analysis. At this point, the best evidence powerfully demonstrates stroke and TIA patients should be prescribed high dose statin therapy for secondary stroke prevention.
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Affiliation(s)
- Branko N Huisa
- Department of Neuroscience, University of California, San Diego, CA 92103, USA.
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Goldstein LB, Amarenco P, Zivin J, Messig M, Altafullah I, Callahan A, Hennerici M, MacLeod MJ, Sillesen H, Zweifler R, Michael K, Welch A. Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial. Stroke 2009; 40:3526-31. [DOI: 10.1161/strokeaha.109.557330] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Larry B. Goldstein
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Pierre Amarenco
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Justin Zivin
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Michael Messig
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Irfan Altafullah
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Alfred Callahan
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Michael Hennerici
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Mary J. MacLeod
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Henrik Sillesen
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - Richard Zweifler
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - K. Michael
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
| | - A. Welch
- From the Department of Medicine, Division of Neurology, Duke University Medical Center (L.B.G.), Durham, NC; the Department of Neurology, Denis Diderot University (P.A.), Paris, France; the Department of Neurology, University of California (J.Z.), San Diego, Calif; Pfizer (M.M.), New York, NY; Minneapolis Clinic of Neurology (I.A.), Golden Valley, Minn; Neurologic Consultants (A.C.), Nashville, Tenn; the Department of Neurology, University of Heidelberg (M.H.), Mannheim, Germany; the Department of
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Abstract
Cytoprotective or neuroprotective interventions would be of value if they could block the processes leading to delayed neuronal death or if they could delay the period between the onset of ischemia and irreversible necrotic injury, thereby lengthening the period for effective reperfusion therapy. Experimental studies in cell culture systems and laboratory animals show that statins have several potential cytoprotective actions, including promotion of angiogenesis, reduction of clot formation and facilitation of clot lysis, upregulation of endothelial nitric oxide synthase, downregulation of inducible nitric oxide synthase, reduction of excitotoxicity, and modulation of the inflammatory response. Clinically, statins appear to protect against vasospasm-related ischemic injury after subarachnoid hemorrhage. There have been no prospective randomized trials aimed at determining whether statins reduce acute stroke severity, and observational studies have had inconsistent results. Although a prospective, randomized trial assessing the effect of pre- or poststroke statin treatment on initial stroke severity would be the most appropriate study design to test for this type of effect, it is unlikely that such a trial will be conducted given the benefits of these drugs in reducing the risk of cardiovascular events and stroke in high-risk populations.
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Affiliation(s)
- Larry B Goldstein
- Department of Medicine (Neurology), Duke Stroke Center, Duke University Medical Center, Durham, NC 27710, USA.
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Martínez-Sánchez P, Rivera-Ordóñez C, Fuentes B, Ortega-Casarrubios MA, Idrovo L, Díez-Tejedor E. The beneficial effect of statins treatment by stroke subtype. Eur J Neurol 2009; 16:127-33. [DOI: 10.1111/j.1468-1331.2008.02370.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Samson RH. Have statins changed the natural history of atheromatous disease and its treatment? Semin Vasc Surg 2008; 21:160-4. [PMID: 18774452 DOI: 10.1053/j.semvascsurg.2008.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Statins are among the most widely prescribed medications in the world and there are now numerous clinical trials demonstrating the beneficial effects of these medications on the natural history of atheromatous disease and its treatment. There is now voluminous data to show that patients treated by vascular surgeons benefit from statins and that these medications do effect the natural history of atheroma, its consequences, and treatment. This article will attempt to summarize the more relevant data that highlights the beneficial effects of statins in patients with peripheral arterial disease and how use of these drugs affects cardio-, peripheral, and cerebrovascular risk.
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Samson RH. The Role of Statin Drugs in the Management of the Peripheral Vascular Patient. Vasc Endovascular Surg 2008; 42:352-66. [DOI: 10.1177/1538574408320524] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The impact of statin therapy on established vascular conditions and recurrent disease is most relevant for long-term care. Patients receiving statin therapy have been shown to experience less recurrent stenosis following carotid endarterectomy and stent angioplasty, reduced cardiac events following cardiac and noncardiac vascular surgery, and reduction in aneurysm development. In patients with peripheral arterial disease, claudication distance is increased, as well as patency rates following infrainguinal arterial bypass grafting. Of note, statins drugs may also prove beneficial in the prevention of certain cancers, Alzheimer's disease, and osteoporosis (all diseases frequently seen concurrently in the patient with peripheral arterial disease). As such, it is becoming all the more necessary that vascular surgeons remain informed about clinical research initiatives related to statin use and lipid management in general. The following is a review of lipid metabolism as it applies to statins as well as a review of the beneficial effects of statins.
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Affiliation(s)
- Russell H. Samson
- From Florida State University Medical School and the Mote Vascular Foundation, Inc, Sarasota, Florida,
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Levin AI. Till death us do part? Postoperative statin discontinuation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2008. [DOI: 10.1080/22201173.2008.10872514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are the most commonly prescribed agents for hypercholesterolemia and have revolutionized the management of hyperlipidemia and the area of cardiovascular risk reduction. However, recent data suggest that their effects go well beyond the lipid lowering seen with long-term use and may include acute antiinflammatory activity, anticoagulation, immunomodulation, as well as promotion of changes in smooth-muscle tone. Because of these data, promising research has begun into the use of these agents in various critical care areas such as the early phases of sepsis, bacteremia, and ischemic stroke. Recent data also show a decrease in cerebral vasospasm after subarachnoid hemorrhage, an area deficient in therapeutic options. More research is necessary to ascertain the true role of statins in the treatment of these various disorders. Nevertheless, the concept of a statin's role as being only a routine preventive therapy with benefits limited to patients undergoing extended treatment is rapidly becoming inaccurate.
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Affiliation(s)
- Kyle A Weant
- Department of Pharmacy, University of North Carolina Hospitals, University of North Carolina at Chapel Hill School of Pharmacy, North Carolina 27514, USA.
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Sugiura S, Yagita Y, Sasaki T, Todo K, Terasaki Y, Ohyama N, Hori M, Kitagawa K. Postischemic administration of HMG CoA reductase inhibitor inhibits infarct expansion after transient middle cerebral artery occlusion. Brain Res 2007; 1181:125-9. [DOI: 10.1016/j.brainres.2007.08.069] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 08/17/2007] [Accepted: 08/25/2007] [Indexed: 01/28/2023]
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Fuentes B, Ortega-Casarrubios MA, Martínez P, Díez-Tejedor E. Action on vascular risk factors: importance of blood pressure and lipid lowering in stroke secondary prevention. Cerebrovasc Dis 2007; 24 Suppl 1:96-106. [PMID: 17971644 DOI: 10.1159/000107384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Secondary stroke prevention comprises a broad spectrum of therapeutic actions that includes the appropriate management of risk factors and the action on blood pressure and serum lipids that are of great importance to decrease stroke recurrences. METHODS We conducted a review of the published studies analyzing the relevance of the treatment of blood pressure and serum lipids, with special attention to recent findings of clinical trials and current guidelines on stroke secondary prevention. RESULTS The relationship between blood pressure and stroke has been widely demonstrated; however, the role of serum lipids has been discussed for a long time. Recent results from epidemiological studies and clinical trials have demonstrated its role as modifiable risk factor for stroke. Blood pressure and lipid lowering are associated with significant reductions in recurrent strokes as well as in other vascular events in transient ischemic attack (TIA) or stroke patients. The PROGRESS and MOSES trials suggest that diuretics, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers could confer additional benefits in stroke patients, and the SPARCL study did so for statins. These drugs are not only efficacious in the reduction of stroke recurrences, but also in other cardiovascular events. CONCLUSIONS Blood pressure and serum lipids are two important and modifiable vascular risk factors that should be taken into consideration when planning secondary stroke prevention measures. This approach should include hypotensive drugs (mainly the combination of diuretics and ACE inhibitors) with the objective to maintain normal blood pressure, avoiding levels >130/80 mm Hg in all stroke patients, and statins (atorvastatin 80 mg) in patients with noncardioembolic TIA or stroke.
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Affiliation(s)
- B Fuentes
- Stroke Unit, Department of Neurology, University Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain
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Affiliation(s)
- Michael A Moskowitz
- Department of Radiology, Neuroscience Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Abstract
There is a compelling need to develop cell and pharmacological therapeutic approaches to be administered beyond the hyperacute phase of stroke. These therapies capitalize on the capacity of the brain for neuroregeneration and neuroplasticity and are designed to reduce neurological deficits after stroke. This review provides an update of bone marrow-derived mesenchymal stem cells (MSCs) and select pharmacological agents in clinical use for other indications that promote the recovery process in the subacute and chronic phases after stroke. Among these agents are 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins), erythropoietin (EPO), and phosphodiesterase type 5 (PDE-5) inhibitors and nitric oxide (NO) donors. Both the MSCs and the pharmacologic agents potentiate brain plasticity and neurobehavioral recovery after stroke.
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Affiliation(s)
- Jieli Chen
- />Department of Neurology, Henry Ford Health Sciences Center, Detroit, Michigan
| | - Michael Chopp
- />Department of Neurology, Henry Ford Health Sciences Center, Detroit, Michigan
- />Department of Physics, Oakland University, Rochester, Michigan
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Abstract
BACKGROUND AND PURPOSE Statins reduce the risk for myocardial infarctions and stroke which may in part depend on cholesterol-independent (pleiotropic) vasoprotective effects. Here, we review evidence to suggest that the abrupt discontinuation of statin medication exerts negative vascular effects in patients with acute vascular events. SUMMARY OF REVIEW It is increasingly recognized that statins (HMG-CoA reductase inhibitors) exert rapid cholesterol-independent effects. Cessation of statin treatment confers overshoot activation of heterotrimeric G-proteins Rho and Rac causing production of reactive oxygen species and suppression of NO bioavailability. In humans, discontinuation of statin therapy leads to a proinflammatory, prothrombotic state with impaired endothelium function. In patients with acute coronary syndromes, abrupt discontinuation of statin therapy significantly increases morbidity and mortality, whereas in stable vascular patients discontinuation may be safe. Recent prospective data indicated that the cessation of statin medication in acute ischemic stroke patients confers a significantly higher likelihood of early neurological deterioration and poor outcome. CONCLUSIONS We propose that in all acute ischemic stroke patients chronically treated with statins before the event, treatment should be continued and the patient should receive medication at the day of the stroke.
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Affiliation(s)
- Matthias Endres
- Klinik und Polikinik für Neurologie, Charité Universitätsmedizin Berlin, Charité Campus Mitte, D-10117 Berlin, Germany.
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Labiós M, Martínez M, Gabriel F. Papel de la atorvastatina en la prevención del ictus. ¿Puede estar relacionado con su acción sobre la activación plaquetaria? Consideraciones basadas en nuestra propia experiencia. HIPERTENSION Y RIESGO VASCULAR 2006. [DOI: 10.1016/s1889-1837(06)71650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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