Atorvastatin in stroke: a review of SPARCL and subgroup analysis

Zivin, Justin A.; Stemer,

doi:10.2147/vhrm.s6795

Cited by 15 publications

(4 citation statements)

References 51 publications

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“…Giving folic acid and B vitamins helps reduce homocysteine levels, which are currently known risk factors for stroke [7]. Simvastatin was also administered to this patient following the SPARCL trial, which discovered the benefts of statin therapy in lowering the risk of stroke [8]. Because hypertension is the most severe risk factor, blood pressure must be maintained in every stroke patient who has hypertension.…”

Section: Discussionmentioning

confidence: 99%

Comprehensive Management of Acute Ischemic Stroke in Psoriatic Patient

Rasyid

Mesiano

Kurniawan

et al. 2023

Case Reports in Dermatological Medicine

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Background. Stroke is one of the top causes of death and disability in several nations. Patients with psoriasis are susceptible to multiple comorbidities, including stroke. In addition to acute ischemic stroke, psoriasis and chronic inflammation require comprehensive treatment. Here, we present a comprehensive management case of a patient with an acute ischemic stroke and psoriasis. Case Presentation. A 42-year-old man came to the emergency department complaining of sudden left-sided weakness that started two and a half hours before being admitted to the hospital. The patient was treated with cyclosporine from 2013 to 2019 for a history of psoriasis. The patient was then treated for secondary stroke prevention using aspirin, vitamin B6, vitamin B12, folic acid, simvastatin, cyclosporine, and topical treatment. After two days of treatment, the patient’s condition improved clinically, and he was discharged without further neurological deficits. As a home medication, the patient’s cyclosporine was switched to the initial dose of methotrexate (7.5 mg/week) and titrated weekly to a response dose of 10 mg in the 10th week. After three months of follow-up, the patient’s condition remained stable, devoid of similar symptoms or sequelae. Conclusions. Cyclosporine should only be used for a maximum of 1 year for stroke management with psoriasis and be substituted for other systemic agents such as methotrexate. In addition, anticoagulants, antihypertensive, antihyperlipidemic, vitamin B6, vitamin 12, and folic acid regimens are highly recommended for comprehensive therapy of cardiovascular comorbidities.

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Section: Discussionmentioning

confidence: 99%

Comprehensive Management of Acute Ischemic Stroke in Psoriatic Patient

Rasyid

Mesiano

Kurniawan

et al. 2023

Case Reports in Dermatological Medicine

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“…These results may serve as a practical reflection of prior randomized controlled trials and several observational analyses which highlight the statin associated risk reduction of stroke. 4,21,22…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Disease Risk–Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network

Saeed

Zhu

Thoma³

et al. 2021

Circ: Cardiovascular Quality and Outcomes

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Background: Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk. Methods: Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013–2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%–7.4%), intermediate (7.5%–19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization. Results: Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07–1.24]) and high risk (hazard ratio=1.27 [1.17–1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI. Conclusions: In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention.

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“…Clinical studies showed patients with postischemic-stroke treatment with atorvastatin showed improving neurological recovery [ 105 ]. However, this beneficial effect is partly counteracted by an increased risk of hemorrhagic stroke [ 106 ]. Moreover, atorvastatin induced intracranial hemorrhages in wildtype fish [ 107 ] and induced cerebral hemorrhage in a zebrafish model ( Figure 8 ), which offers an opportunity to screen cerebrovascular-protective compounds.…”

Section: Cerebral Hemorrhage Modelmentioning

confidence: 99%

From Omics to Drug Metabolism and High Content Screen of Natural Product in Zebrafish: A New Model for Discovery of Neuroactive Compound

Hung

Zhang

et al. 2012

Evidence-Based Complementary and Alternative Medicine

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The zebrafish (Danio rerio) has recently become a common model in the fields of genetics, environmental science, toxicology, and especially drug screening. Zebrafish has emerged as a biomedically relevant model for in vivo high content drug screening and the simultaneous determination of multiple efficacy parameters, including behaviour, selectivity, and toxicity in the content of the whole organism. A zebrafish behavioural assay has been demonstrated as a novel, rapid, and high-throughput approach to the discovery of neuroactive, psychoactive, and memory-modulating compounds. Recent studies found a functional similarity of drug metabolism systems in zebrafish and mammals, providing a clue with why some compounds are active in zebrafish in vivo but not in vitro, as well as providing grounds for the rationales supporting the use of a zebrafish screen to identify prodrugs. Here, we discuss the advantages of the zebrafish model for evaluating drug metabolism and the mode of pharmacological action with the emerging omics approaches. Why this model is suitable for identifying lead compounds from natural products for therapy of disorders with multifactorial etiopathogenesis and imbalance of angiogenesis, such as Parkinson's disease, epilepsy, cardiotoxicity, cerebral hemorrhage, dyslipidemia, and hyperlipidemia, is addressed.

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Atorvastatin in stroke: a review of SPARCL and subgroup analysis

Cited by 15 publications

References 51 publications

Comprehensive Management of Acute Ischemic Stroke in Psoriatic Patient

Comprehensive Management of Acute Ischemic Stroke in Psoriatic Patient

Cardiovascular Disease Risk–Based Statin Utilization and Associated Outcomes in a Primary Prevention Cohort: Insights From a Large Health Care Network

From Omics to Drug Metabolism and High Content Screen of Natural Product in Zebrafish: A New Model for Discovery of Neuroactive Compound

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