Intensive Statin Treatment in Acute Ischaemic Stroke Patients with Intracranial Atherosclerosis: a High-Resolution Magnetic Resonance Imaging study (STAMINA-MRI Study)

Chung, Jong‐Won; Cha, Jihoon; Lee, Mi Ji; Yu, Inwu; Park, Moo‐Seok; Seo, Woo‐Keun; Kim, Sung Tae; Bang, Oh Young

doi:10.1136/jnnp-2019-320893

Cited by 55 publications

(57 citation statements)

References 51 publications

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“…Miao et al reported that the degree of stenosis in asymptomatic ICAS can be alleviated with intensive lipid-lowering therapy using statin for Chinese patients with asymptomatic ICAS (32). Chung et al found that high-dose statin treatment can significantly decrease the LDL-C levels and effectively stabilize symptomatic intracranial atherosclerotic plaques as documented by HR-MRI (33). Evidence above suggests that LDL-C may play a role in the formation and progression of ICAS, and maintaining LDL in a normal range may be the right choice for preventing ICAS in clinical practice.…”

Section: Discussionmentioning

confidence: 97%

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Kang

et al. 2020

Front. Neurol.

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Background and Purpose: Intracranial atherosclerosis has gained increasing attention due to the high risk of recurrent clinical or subclinical ischemic events, while the relationship between low-density lipoprotein cholesterol (LDL-C) measured at a single time point and intracranial atherosclerotic stenosis (ICAS) is inconsistent. This study aims to assess the association between cumulative exposure to increased LDL-C and the prevalence of asymptomatic ICAS.Methods: The Asymptomatic Polyvascular Abnormalities Community study was investigated on the epidemiology of asymptomatic polyvascular abnormalities in Chinese adults. In this study, we included 4,523 participants with LDL-C measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to increased LDL-C was calculated as following: LDL-C burden2006−2008 = [(LDL-C2006-1.8) + (LDL-C2008-1.8)]/2 * time2006−2008; LDL-C burden = LDL-C burden2006−2008 + LDL-C burden2008−2010. Transcranial doppler ultrasonography was performed in 2010 to detecting the ICAS.Results: Of the 4,347 patients, 13.3% (580/4,347) were diagnosed with ICAS. In univariate analysis, the association between LDL-C burden and ICAS prevalence was significant, the odds ratios (95% confidence interval) from the lowest to the highest quartile were 1 (reference), 1.30 (0.99–1.70), 1.32 (1.01–1.73), and 2.14 (1.66–2.75), respectively (P < 0.05). After adjustment for potential confounding factors, the same result was reached.Conclusions: Cumulative exposure to increased LDL-C is concentration-dependently associated with increased prevalence of asymptomatic ICAS, especially in those under the age of 65 y or free of hypertension, diabetes mellitus, and hyperlipidemia.

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Section: Discussionmentioning

confidence: 97%

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Kang

et al. 2020

Front. Neurol.

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“…There have been few studies on lipid-lowering therapies that exclusively focus on ICAS. In a recent study, 55 the investigators enrolled statin-naïve patients with ischemic stroke who had symptomatic ICAS (>50% stenosis) in the proximal portion of the MCA, BA, or intracranial portion of the ICA. Atorvastatin (40 to 80 mg) or rosuvastatin (20 mg) was administered for 6 months, and patients underwent HR-MRI before and after statin treatment.…”

Section: Lipid-lowering Therapy In Patients With Intracranial Atherosclerosismentioning

confidence: 99%

“…These data suggest that diagnosis based solely on angiogram findings may not be accurate, which may explain why the effect of statins was not consistent in patients with ICAS. 55…”

Section: Lipid-lowering Therapy In Patients With Intracranial Atherosclerosismentioning

confidence: 99%

Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines

Kim

2021

J Stroke

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Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of “high-intensity statins” and “low LDL-C target” strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.

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“…Since the hydrophilic group of statins is similar to the HMG portion of the substrate [3], statins can be used as competitive inhibitors of HMG-CoA. Therefore, statins can reduce cholesterol synthesis to prevent cardiovascular diseases such as atherosclerosis [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Pleiotropic use of Statins as non-lipid-lowering drugs

Zhang¹,

Dong²,

2020

Int. J. Biol. Sci.

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Statins, known as HMG-CoA reductase (HMGCR) inhibitors, have primarily been utilized for metabolic and angiographic medical applications because of their cholesterol-lowering effects. Similar to other drugs, statins may also induce a series of potential side effects. Statins inhibit the HMGCR (rate-limiting enzyme) activity in early stages of mevalonate pathway and then indirectly affect a number of intermediate products, including non-sterol isoprenoids (coenzyme Q10, dolichol etc.), which can result in impaired functions of body organs. Recently, scores of studies have uncovered additional functional mechanisms of statins in other diseases, such as diabetes mellitus, nervous system diseases, coronary heart disease, inflammation and cancers. This review aims to summarize the positive and adverse mechanisms of statin therapy. Statin care should be taken in the treatment of many diseases including cancers. Since the underlying mechanisms are not fully elucidated, future studies should spend more time and efforts on basic research to explore the mechanisms of statins.

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Intensive Statin Treatment in Acute Ischaemic Stroke Patients with Intracranial Atherosclerosis: a High-Resolution Magnetic Resonance Imaging study (STAMINA-MRI Study)

Cited by 55 publications

References 51 publications

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Association Between Cumulative Exposure to Increased Low-Density Lipoprotein Cholesterol and the Prevalence of Asymptomatic Intracranial Atherosclerotic Stenosis

Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines

Pleiotropic use of Statins as non-lipid-lowering drugs

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