Better outcome after stroke with higher serum cholesterol levels

Vauthey, C.; Freitas, Gabriel R. de; Melle, Guy van; Devuyst, G.; Bogousslavsky, Julien

doi:10.1212/wnl.54.10.1944

Cited by 148 publications

(109 citation statements)

References 43 publications

(42 reference statements)

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“…Similarly, the Eastern Stroke and Coronary The relationship between stroke and cholesterol becomes even more complex with the notion that stroke outcome might be negatively associated with cholesterol levels. For example, the Lausanne Stroke Registry demonstrated that stroke patients with higher cholesterol levels had better outcomes after 1 month (Vauthey et al, 2000). In agreement with this, a retrospective study performed by Dyker et al (1997) found more patients dead or disabled after stroke with low cholesterol levels at stroke onset (Dyker et al, 1997).…”

Section: Stroke and Cholesterol: The First Paradoxmentioning

confidence: 64%

Statins and Stroke

Endres

2005

J Cereb Blood Flow Metab

160

110

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Inhibitors of HMG-CoA reductase (statins) are potent cholesterol-lowering drugs. Large clinical trials have shown that statins reduce the incidence of cerebrovascular events, which might be surprising because cholesterol is not an established risk factor for stroke. In addition to their cholesterollowering properties, statins exert a number of pleiotropic, vasculoprotective actions that include improvement of endothelial function, increased nitric oxide (NO) bioavailability, antioxidant properties, inhibition of inflammatory responses, immunomodulatory actions, regulation of progenitor cells, and stabilization of atherosclerotic plaques. In fact, statins augment cerebral blood flow and confer significant protection in animal models of stroke partly via mechanisms related to the upregulation of endothelial nitric oxide synthase. Retrospective clinical evidence suggests that long-term statin administration may not only reduce stroke risk but also improve outcome. Early secondary prevention trials are underway to test the hypothesis that statin treatment initiated immediately after an event improves short-term outcome. Lastly, recent evidence suggests that sudden discontinuation of statin treatment leads to a rebound effect with downregulation of NO production. Withdrawal of statin treatment may impair vascular function and increase morbidity and mortality in patients with vascular disease.

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Section: Stroke and Cholesterol: The First Paradoxmentioning

confidence: 64%

Statins and Stroke

Endres

2005

J Cereb Blood Flow Metab

160

110

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“…Furthermore, pre-existent hypercholesterolaemia independently predicted a better quality of life after 6 months. High cholesterol levels in the acute phase of stroke have been associated with a better functional outcome at 1 month post-stroke [48]. Alternatively, this association may be explained by the use of statins by these patients.…”

Section: Gms Nys Et Al / Journal Of the Neurological Sciences XX mentioning

confidence: 99%

Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke

Nys¹,

Zandvoort²,

Worp³

et al. 2006

Journal of the Neurological Sciences

245

188

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Objective: The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors. Methods: We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery Å sberg Depression Rating Scale ! 7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression. Results: Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most. Conclusions: Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS. D

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“…As "protective" factors, the following have been reported as associated with lower long-term mortality: stroke due to dissection of extracranial arteries, stroke associated with migraine, permanent poststroke anticoagulation therapy (in patients with cardioembolic stroke or potential cardiac sources of emboli and patients with hypercoagulable states) (RR 0. young [10,12] as well as in elderly [39]. This is due to the neuroprotective effect of drugs such as statins or fibrates, which are prescribed in young adults with stroke and hypercholesterolemia.…”

Section: Risk Factors For Mortalitymentioning

confidence: 99%

Long-term prognosis of ischemic stroke in young adults

et al. 2004

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There is limited information about long-term prognosis of ischemic stroke in young adults. Giving the potentially negative impact in physical, social, and emotional aspects of an ischemic stroke in young people, providing early accurate long-term prognostic information is very important in this clinical setting. Moreover, detection of factors associated with bad outcomes (death, recurrence, moderate-to-severe disability) help physicians in optimizing secondary prevention strategies. The present paper reviews the most relevant published information concerning long-term prognosis and predictors of unfavorable outcomes of ischemic stroke affecting young adults. As a summary, we can conclude that, in the long term, stroke in the young adult increases slightly the risk of mortality, implies higher risk of future cardiovascular events, and determines functional limitations in a significant percentage of patients. Nevertheless, in every individual case the prognosis has to be considered depending on several factors (stroke subtype, initial severity, cardiovascular risk factors) that determine the long-term outcomes.

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Better outcome after stroke with higher serum cholesterol levels

Abstract: The authors' findings suggest that higher levels of cholesterol are associated with a better outcome in the early phase after ischemic stroke.

Cited by 148 publications

References 43 publications

Statins and Stroke

Statins and Stroke

Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke

Long-term prognosis of ischemic stroke in young adults

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