An Association of Prior Statin Use with Decreased Perihematomal Edema

Naval, Neeraj S.; Abdelhak, Tamer; Urrunaga, Nathalie H.; Zeballos, Paloma; Mirski, Marek A.; Carhuapoma, J. Ricardo

doi:10.1007/s12028-007-0081-1

Cited by 65 publications

(43 citation statements)

References 46 publications

(53 reference statements)

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“…20,21 A retrospective study found that prior statin use was associated with reduced perihematomal edema and improved survival in a series of patients with nontraumatic intracerebral hemorrhage. 22,23 Analysis of SPARCL data found that statin treatment was associated with an increased risk of hemorrhagic stroke in subjects with prior stroke that was independent of other factors. 1,19 Although limited by small numbers and therefore low statistical power, the current analysis found no difference in the outcomes of hemorrhagic strokes (Figure, bottom panel).…”

Section: Discussionmentioning

confidence: 99%

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Goldstein

Amarenco

Zivin

et al. 2009

Stroke

116

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on behalf of the SPARCL InvestigatorsBackground and Purpose-Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces strokes in subjects with recent stroke or transient ischemic attack (nϭ4731). We analyzed SPARCL trial data to determine whether treatment favorably shifts the distribution of severities of ischemic cerebrovascular outcomes. Methods-Severity was assessed with the National Institutes of Health Stroke Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. Results-Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5 or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (PϽ0.001 unadjusted and adjusted). Results were similar for all outcome events (ischemic and hemorrhagic, PϽ0.001 unadjusted and adjusted) with no effect on outcome hemorrhagic stroke severity (Pϭ0.174 unadjusted, Pϭ0.218 adjusted). If the analysis is restricted to those having an outcome ischemic stroke (ie, excluding those having a transient ischemic attack or no event), there was only a trend toward lesser severity with treatment based on the modified Rankin Scale score (Pϭ0.0647) with no difference based on the National Institutes of Health Stroke Scale or Barthel Index. Conclusion-The

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Section: Discussionmentioning

confidence: 99%

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Goldstein

Amarenco

Zivin

et al. 2009

Stroke

116

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“…Retrospective studies on ICH patients in Johns Hopkins Hospital from 1999 to 2006 suggested association of prior statin use with decreased mortality (75) and decreased perihematomal edema (76). On the other hand, a prospective cohort study did not find association between prior use of statins and improvement in functional outcome or mortality after ICH (77).…”

Section: Statinsmentioning

confidence: 99%

Exploring Neuroprotective Drug Therapies for Intracerebral Hemorrhage

Katsuki

2010

J Pharmacol Sci

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Abstract. Intracerebral hemorrhage (ICH) is a devastating neurological disorder with high mortality and poor prognosis, for which virtually no effective drug therapies are available at present. Experimental animal models, based on intrastriatal injection of collagenase or autologous blood, have enabled great advances in elucidation of cellular/molecular events contributing to brain pathogenesis associated with ICH. Many lines of evidence indicate that blood constituents, including hemoglobin-derived products as well as proteases such as thrombin, play important roles in the pathogenic events. Inflammatory reactions involving neutrophils, activated microglia, and production of proinflammatory cytokines also constitute a critical aspect of pathology leading to neurodegeneration and tissue damage. Efforts are continuing to find drugs that potentially alleviate pathologi cal and neurological outcomes of ICH. Various drugs that possess antioxidative, antiinflammatory or neurotrophic/neuroprotective properties have been demonstrated to produce therapeutic effects on ICH animal models. Drugs already in clinical use such as minocycline, statins, and several nuclear receptor ligands are among the list of effective drugs, but whether they also show therapeutic efficacy in human ICH patients remains unproven. Here, current knowledge of ICH pathogenesis and problems arising with respect to exploration of new drug candidates are discussed.

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“…Retrospective evaluation in a cohort of ICH patients demonstrated that prior statin use was found to be associated with decreased mortality with a greater than 12-fold odds of survival (p=0.05). The same patient population also demonstrated an association between statin use prior to ICH and decreased absolute and relative perihematomal edema at presentation [132]. There is a report of 1 small, prospective cohort of 18 patients treated with rosuvastatin compared to 57 historical controls [133].…”

Section: Anti-inflammatory Agents: Statinsmentioning

confidence: 87%

Treatment Targets in Intracerebral Hemorrhage

Sangha

Gonzales

2011

Neurotherapeutics

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Intracerebral hemorrhage (ICH) imparts a higher mortality and morbidity than ischemic stroke. The therapeutic interventions that are currently available focus mainly on supportive care and secondary prevention. There is a paucity of evidence to support any one acute intervention that improves functional outcome. This chapter highlights current treatment targets for ICH based on the pathophysiology of the disease.

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An Association of Prior Statin Use with Decreased Perihematomal Edema

Abstract: We report the association between statin use prior to ICH and decreased absolute and relative perihematomal edema. A prospective study analyzing the role of statins in perihematomal edema reduction and the resultant effect on mortality and functional outcomes following ICH is warranted.

Cited by 65 publications

References 46 publications

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Exploring Neuroprotective Drug Therapies for Intracerebral Hemorrhage

Treatment Targets in Intracerebral Hemorrhage

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