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Jamialahmadi T, Baratzadeh F, Reiner Ž, Mannarino MR, Cardenia V, Simental-Mendía LE, Pirro M, Watts GF, Sahebkar A. The Effects of Statin Therapy on Oxidized LDL and Its Antibodies: A Systematic Review and Meta-Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:7850659. [PMID: 35958018 PMCID: PMC9359854 DOI: 10.1155/2022/7850659] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/06/2022] [Indexed: 02/04/2023]
Abstract
Background Elevated serum low-density lipoproteins (LDL), the substrate for the formation of atherogenic oxidized LDLs (oxLDL), are a causal factor for atherosclerotic cardiovascular disease (ASCVD). Statins are well known to decrease LDL particle concentration and reduce ASCVD morbidity and mortality. Objective To perform a meta-analysis of the effects of statins (i.e., type, dose, and duration of treatment) on serum levels of oxLDL and on immunoglobulin M (IgM) and immunoglobulin G (IgG) antibody levels against oxLDL. Methods PubMed, Scopus, Embase, and Web of Science were searched up to February 5th, 2021, for randomized controlled trials (RCT) evaluating the effect of statins on oxLDL and anti-oxLDL antibody levels. Meta-analysis was performed using Comprehensive Meta-Analysis (CMA) V2 software. To evaluate the influence of each study on the overall effect size, a sensitivity analysis was performed using the leave-one-out method. Evaluation of the funnel plot, Begg's rank correlation, and Egger's weighted regression tests was used to assess the presence of publication bias in the meta-analysis. Results A total of 28 RCTs including 4019 subjects were finally included in the meta-analysis. The results indicated a significant decrease in circulating concentrations of oxLDL after treatment with statins (SMD: -2.150, 95% CI: -2.640, -1.697, p < 0.001). Subgroup analysis found no significant effect of the intensity of statin treatment or statin lipophilicity on the reduction of circulating concentrations of oxLDL. An additional meta-analysis of 3 trials showed that statins did not change the serum levels of IgM and IgG antibodies to oxLDL. Conclusion Statin therapy decreases serum oxLDL concentrations but does not affect circulating levels of anti-oxLDL antibodies.
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Affiliation(s)
- Tannaz Jamialahmadi
- Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Baratzadeh
- Department of Clinical Pharmacy, School of Pharmacy, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Massimo R. Mannarino
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Perugia, Italy
| | - Vladimiro Cardenia
- Department of Agricultural, Forest and Food Sciences (DISAFA), University of Turin, Grugliasco 10095, Italy
| | | | - Matteo Pirro
- Unit of Internal Medicine, Angiology and Arteriosclerosis Diseases, Department of Medicine, University of Perugia, Perugia, Italy
| | - Gerald F. Watts
- Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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Wu B, Wang Y, Li W, Dong R, Dun C. The effect of rosuvastatin on cardiogenic cerebral infarction. Am J Transl Res 2021; 13:9444-9450. [PMID: 34540064 PMCID: PMC8430200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/22/2020] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effect of rosuvastatin on cardiogenic cerebral infarction and its related effects on patients' neurological function, lipid levels, inflammatory factor levels, and oxidative stress status. METHODS 300 patients with cardiogenic cerebral infarction were recruited as the study cohort and randomly divided into an observation group and a control group. Routine treatment, including urinary kallikrein injections and bayaspirin tablets were given to the patients in the control group for one month. Rosuvastatin was given once a day in addition to the treatment the control group received to the patients in the observation group, also for one month. The two groups' treatment efficacies were compared. Also, the two groups' NIHSS and mRS scores, lipid and inflammatory factor levels, and their oxidative stress statuses were also compared. RESULTS The total effective rate in the observation group was significantly higher than it was in the control group (74.0% vs 84.7%, P=0.023). The NIHSS and mRS scores in the observation group were significantly lower than they were in the control group (all P<0.001). Compared with their levels after the treatment in the control group, the cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) levels in the observation group were significantly decreased and the high-density lipoprotein cholesterol (HDL-C) was significantly increased (all P<0.001). Moreover, after the treatment, the inflammatory factors, such as the tumor necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) levels, and the oxidative stress status, such as the oxidatively modified low density lipoprotein (ox-LDL) levels, were significantly lower than they were in the control group, but the superoxide dimutase (SOD) levels were significantly higher. CONCLUSIONS Rosuvastatin remarkably improves the treatment efficacy and neurological function in cardiogenic cerebral infarction patients, and is associated with the improvement of the lipid levels, the inflammatory response, and the oxidative stress status.
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Affiliation(s)
- Bin Wu
- The First Department of Neurology, Tangshan People’s HospitalTangshan, Hebei Province, China
| | - Yan Wang
- The First Department of Neurology, Tangshan People’s HospitalTangshan, Hebei Province, China
| | - Wei Li
- The First Department of Neurology, Tangshan People’s HospitalTangshan, Hebei Province, China
| | - Ruifang Dong
- Department of Neurology, Cangzhou Central HospitalCangzhou, Hebei Province, China
| | - Changping Dun
- The First Department of Neurology, Tangshan People’s HospitalTangshan, Hebei Province, China
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Xu T, Wang Y, Yuan J, Chen Y. The Effect of Statin Treatment on Outcomes of Cardioembolic Stroke: A Systematic Review and Meta-Analysis of Real-World Studies. CNS Drugs 2021; 35:717-726. [PMID: 34019256 DOI: 10.1007/s40263-021-00829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Several real-world observational studies have investigated the association between statin treatment and outcomes of cardioembolic stroke. However, substantial uncertainties remain about this association. OBJECTIVE We aimed to perform a systematic review and meta-analysis to determine the effect of statin treatment on the outcomes of cardioembolic stroke. METHODS We systematically searched the PubMed and Embase databases for relevant clinical studies. Pooled relative risks (RRs) and 95% confidence intervals (CIs) with a random-effects model were used to assess the outcomes of interest. RESULTS A total of 18 observational studies published between 2009 and 2020 were included. No randomized clinical trial was found. Compared with non-statin treatment, statin treatment was not associated with a decreased risk of stroke recurrence in patients with cardioembolic stroke [PWCS] (RR, 0.93; 95% CI 0.82-1.06). However, compared with non-statin treatment, statin treatment was associated with a lower risk of all-cause death (RR, 0.59; 95% CI 0.49-0.73) and better functional outcomes (RR, 0.67; 95% CI 0.47-0.97) in PWCS. There was no significant association between statin treatment and major bleeding event risk in PWCS (RR, 0.35; 95% CI 0.06-2.16). Compared with non-statin treatment, statin treatment was not associated with a decreased risk of coronary atherosclerotic disease in PWCS (RR, 1.04; 95% CI 0.96-1.11). CONCLUSIONS Although the use of statins does not enhance the prevention of stroke recurrence in PWCS, statin treatment is associated with improved clinical outcomes in PWCS. Statins play a beneficial role in the treatment of cardioembolic stroke.
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Affiliation(s)
- Tao Xu
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - You Wang
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Jinxian Yuan
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yangmei Chen
- Department of Neurology, The Second Affiliated Hospital of Chongqing Medical University, Number 76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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Lu T, Yang X, Cai Y, Xie C, Zhang B. Prestroke Statins Improve Prognosis of Atrial Fibrillation-Associated Stroke through Increasing Suppressor of Cytokine Signaling-3 Levels. Eur Neurol 2021; 84:96-102. [PMID: 33684912 DOI: 10.1159/000513767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cerebral infarction associated with atrial fibrillation (AF) has relatively higher mortality and morbidity rates than other types of stroke. Statins are being commonly prescribed to patients with stoke. However, the use of statins in AF-related stroke, especially prestroke, has not been well studied. This study aimed to investigate whether the use of prestroke statins could improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS) and its mechanism. METHODS This prospective study enrolled 453 AF-associated AIS patients from 4 medical centers and divided them into 2 groups based on the statin use before the stroke episode. All patients received comprehensive clinical examinations including 72-h Holter electrocardiogram monitoring and were followed up for 3 months. Plasma suppressor of cytokine signaling-3 (SOCS-3) and matrix metalloproteinase-9 (MMP-9) levels were measured by ELISA on admission and days 3 and 7 after enrollment. The endpoints were death, major disability (modified Rankin Scale score ≥3), and composite outcome (death/major disability) at 3 months after the AIS episode. RESULTS Plasma SOCS-3 levels were significantly increased and MMP-9 levels decreased in patients in the prestroke statin group on hospital admission and days 3 and 7 after enrollment (p < 0.001). Furthermore, our data suggested that baseline plasma SOCS-3 levels were associated with increased risk of 3-month mortality (adjusted odds ratio [OR], 1.012; 95% confidence interval [CI], 1.006-1.018; p < 0.001) and major disability (adjusted OR, 1.013; 95% CI, 1.007-1.02; p < 0.001). Similarly, baseline plasma MMP-9 levels were also associated with increased risk of 3-month mortality (adjusted OR, 1.037; 95% CI, 1.022-1.053; p < 0.001) and major disability (adjusted OR, 1.038; 95% CI, 1.022-1.55; p < 0.001). CONCLUSION Our data suggested that the prestroke use of statins improved the clinical outcomes in AIS patients with AF by upregulating the level of SOCS-3 and reducing the plasma MMP-9 level.
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Affiliation(s)
- Taoli Lu
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, China,
| | - Xu Yang
- Department of Neurology, Nanchong Central Hospital, Nanchong, China
| | - Yanli Cai
- Department of Neurology, Ziyang First People's Hospital, Ziyang, China
| | - Chenchen Xie
- Department of Neurology, The Affiliated Hospital of Chengdu University, Chengdu, China
| | - Bei Zhang
- Department of Neurology, Chengdu Second People's Hospital, Chengdu, China
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Ding WY, Protty MB, Davies IG, Lip GYH. Relationship between lipoproteins, thrombosis and atrial fibrillation. Cardiovasc Res 2021; 118:716-731. [PMID: 33483737 PMCID: PMC8859639 DOI: 10.1093/cvr/cvab017] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/14/2020] [Accepted: 01/12/2021] [Indexed: 12/19/2022] Open
Abstract
The prothrombotic state in atrial fibrillation (AF) occurs as a result of multifaceted interactions, known as Virchow’s triad of hypercoagulability, structural abnormalities, and blood stasis. More recently, there is emerging evidence that lipoproteins are implicated in this process, beyond their traditional role in atherosclerosis. In this review, we provide an overview of the various lipoproteins and explore the association between lipoproteins and AF, the effects of lipoproteins on haemostasis, and the potential contribution of lipoproteins to thrombogenesis in AF. There are several types of lipoproteins based on size, lipid composition, and apolipoprotein category, namely: chylomicrons, very low-density lipoprotein, low-density lipoprotein (LDL), intermediate-density lipoprotein, and high-density lipoprotein. Each of these lipoproteins may contain numerous lipid species and proteins with a variety of different functions. Furthermore, the lipoprotein particles may be oxidized causing an alteration in their structure and content. Of note, there is a paradoxical inverse relationship between total cholesterol and LDL cholesterol (LDL-C) levels, and incident AF. The mechanism by which this occurs may be related to the stabilizing effect of cholesterol on myocardial membranes, along with its role in inflammation. Overall, specific lipoproteins may interact with haemostatic pathways to promote excess platelet activation and thrombin generation, as well as inhibiting fibrinolysis. In this regard, LDL-C has been shown to be an independent risk factor for thromboembolic events in AF. The complex relationship between lipoproteins, thrombosis and AF warrants further research with an aim to improve our knowledge base and contribute to our overall understanding of lipoprotein-mediated thrombosis.
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Affiliation(s)
- Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
| | - Majd B Protty
- Systems Immunity University Research Institute, Cardiff University, Cardiff, United Kingdom
| | - Ian G Davies
- Research Institute of Sport and Exercise Science, Liverpool John Moores University, Liverpool, United Kingdom
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Effects of Pitavastatin on Lipoprotein Subfractions and Oxidized Low-density Lipoprotein in Patients with Atherosclerosis. Curr Med Sci 2020; 40:879-884. [PMID: 33123903 DOI: 10.1007/s11596-020-2263-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 03/04/2020] [Indexed: 02/06/2023]
Abstract
It has been demonstrated that pitavastatin can significantly reduce low-density lipoprotein (LDL) cholesterol (LDL-C), but its impact on lipoprotein subfractions and oxidized low-density lipoprotein (oxLDL) has not been determined. The aim of the present study was to investigate the potential effects of pitavastatin on subfractions of LDL and high-density lipoprotein (HDL) as well as oxLDL in untreated patients with coronary atherosclerosis (AS). Thirty-six subjects were enrolled in this study. Of them, 18 patients with AS were administered pitavastatin 2 mg/day for 8 weeks and 18 healthy subjects without therapy served as controls. The plasma lipid profile, lipoprotein subfractions and circulating oxLDL were determined at baseline and 8 weeks respectively. The results showed that pitavastatin treatment indeed not only decreased LDL-C, total cholesterol (TC), triglycerides (TG) and apolipoprotein B (ApoB) levels, and increased HDL cholesterol (HDL-C), but also reduced the cholesterol concentration of all of the LDL subfractions and the percentage of intermediate and small LDL subfractions. Meanwhile, pitavastatin could decrease plasma oxLDL levels. Furthermore, a more close correlation was found between oxLDL and LDL-C as well as LDL subfractions after pitavastatin treatment. We concluded that a moderate dose of pitavastatin therapy not only decreases LDL-C and oxLDL concentrations but also improves LDL subfractions in patients with AS.
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Eun MY, Jung JM, Choi KH, Seo WK. Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:589684. [PMID: 33162931 PMCID: PMC7581731 DOI: 10.3389/fneur.2020.589684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/11/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Statins lower the risk of recurrent stroke and mortality and improve outcomes in patients with ischemic stroke. However, the effects of statins on atrial fibrillation (AF)-related stroke are not well-established. Our study aims to investigate the effects of statin therapy on the clinical outcomes in patients with AF-related stroke. Methods: Electronic databases (MEDLINE, Embase, and Scopus) were searched for previous studies on the effects of pre- and post-stroke statins on the clinical outcomes in AF-related stroke patients. The primary outcome was all-cause mortality. Secondary outcomes included recurrent ischemic stroke, acute coronary events, major adverse cardiovascular events (MACE), and short-term functional outcomes. We extracted hazard ratios (HRs) or odds ratios (ORs) with 95% confidence interval (CI) from each study and pooled them through a meta-analysis. Results: A total of eight studies (five on post-stroke statins and three on pre-stroke statins) with 12,216 patients were included in the analysis. Post-stroke statin therapy reduced the risk of all-cause mortality (HR, 0.63; 95% CI, 0.55–0.74). This beneficial effect was sustained regardless of statin intensity. However, no significant associations were observed between statin therapy and a reduction in the risk of recurrent ischemic stroke, acute coronary events, or MACE. Pre-stroke statin use was associated with a lower risk of poor short-term functional outcomes (OR, 0.63; 95% CI, 0.47–0.85). Conclusions: Statin therapy for AF-related stroke may reduce all-cause mortality and improve functional outcomes. Randomized controlled studies are warranted to confirm the effects of statins on the outcomes of AF-related stroke.
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Affiliation(s)
- Mi-Yeon Eun
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Jin-Man Jung
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.,Korea University Zebrafish Translational Medical Research Center, Ansan, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, South Korea
| | - Woo-Keun Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Vitturi BK, Gagliardi RJ. Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:461-467. [PMID: 32627806 DOI: 10.1590/0004-282x20200027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Statin therapy has become one of the most important advances in stroke secondary prevention. OBJECTIVE To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. METHODS We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. CONCLUSIONS Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Santa Casa de São Paulo, School of Medical Sciences, Department of Neurology, São Paulo SP, Brazil
| | - Rubens José Gagliardi
- Santa Casa de São Paulo, School of Medical Sciences, Department of Neurology, São Paulo SP, Brazil
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Poupore N, Strat D, Mackey T, Brown K, Snell A, Nathaniel TI. Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients. Lipids Health Dis 2020; 19:84. [PMID: 32375780 PMCID: PMC7201805 DOI: 10.1186/s12944-020-01270-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/27/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue plasminogen activator (rtPA) therapy. In this study, clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy was investigated. METHODS Retrospective data for baseline clinical and demographic data for patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center was analyzed. Improving (NIHSS score ≤ 7) or worsening (NIHSS score > 7) of neurologic functions were the determined measures of treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or improving neurologic functions. RESULTS Adjusted multivariate analysis showed that in an AIS population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. CONCLUSION A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions. While combining statin with rtPA treatment may facilitate worsening neurologic functions in elderly AIS patients with atrial fibrillation, they should not be denied of this therapy. The decision to combine statin and rtPA for AIS patients with atrial fibrillation can be done after clinical stabilization following appropriate clinical management.
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Affiliation(s)
- Nicolas Poupore
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Dan Strat
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Tristan Mackey
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Katherine Brown
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Ashley Snell
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA
| | - Thomas I Nathaniel
- University of South Carolina School of Medicine Greenville, 607 Grove Rd, Greenville, SC, 29605, USA.
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