Regarding Article “Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association”

Palacio, Santiago; Hart, Robert G.

doi:10.1161/strokeaha.110.602474

Cited by 143 publications

(251 citation statements)

References 3 publications

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“…In this study, we determined the risk of ischemic stroke among AF patients categorized as “low risk” using CHA 2 DS 2 ‐VASc score (0) and compared such risk with that of patients with CHA 2 DS 2 ‐VASc score of 1 due to individual score components in order to understand their contributory effects to ischemic stroke. First, we showed that even in AF patients considered “low risk,” that is, those with CHA 2 DS 2 ‐VASc score of 0, the annual risk of ischemic stroke remained substantially higher than that reported in Caucasians . Second, while patients with CHA 2 DS 2 ‐VASc score of 1 were generally at higher risk of ischemic stroke compared with those with CHA 2 DS 2 ‐VASc score of 0, the contributory effects of individual components constituting CHA 2 DS 2 ‐VASc score of 1 to the risk of ischemic stroke varied significantly.…”

Section: Discussionmentioning

confidence: 65%

“…As a result, AF patients with CHA 2 DS 2 ‐VASc score of ≥1, that is, with any single risk factor stipulated in CHA 2 DS 2 ‐VASc score including heart failure, hypertension, diabetes mellitus, age 65–74 years, female gender, and/or vascular disease, would require long‐term anticoagulation. Although these risk factors have been reported to be predictive of ischemic stroke in AF patients, their individual contribution to risk is not uniform. For instance, in the original validation cohort for CHA 2 DS 2 ‐VASc score from Denmark, among patients with CHA 2 DS 2 ‐VASc score of 1, the relative ischemic stroke risk (as assessed with HR) conferred by the six risk factors leading to CHA 2 DS 2 ‐VASc score of 1 differed nearly fivefold .…”

Section: Discussionmentioning

confidence: 99%

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Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Huang

Luo

Yue

et al. 2014

Pacing Clinical Electrophis

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Huang

Luo

Yue

et al. 2014

Pacing Clinical Electrophis

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“…Intracerebral hemorrhage (ICH) is a significant cause of morbidity and mortality throughout the world (Morgenstern et al, 2010; Palacio and Hart, 2011). However, developing a targeted therapy or an effective drug to improve ICH outcomes remains a challenge.…”

Section: Introductionmentioning

confidence: 99%

Pinocembrin protects hemorrhagic brain primarily by inhibiting toll-like receptor 4 and reducing M1 phenotype microglia

Lan

Han

et al. 2017

Brain, Behavior, and Immunity

172

153

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Neuroinflammation is a major contributor to intracerebral hemorrhage (ICH) progression, but no drug is currently available to reduce this response and protect against ICH-induced injury. Recently, the natural product pinocembrin has been shown to ameliorate neuroinflammation and is undergoing a phase II clinical trial for ischemic stroke treatment. In this study, we examined the efficacy of pinocembrin in an ICH model, and further examined its effect on microglial activation and polarization. In vivo, pinocembrin dose-dependently reduced lesion volume by 47.5% and reduced neurologic deficits of mice at 72 h after collagenase-induced ICH. The optimal dose of pinocembrin (5 mg/kg) suppressed microglial activation as evidenced by decreases in CD68-positive microglia and reduced proinflammatory cytokines tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6. Pinocembrin also reduced the number of classically activated M1-like microglia without affecting M2-like microglia in the perilesional region. Additionally, pinocembrin decreased the expression of toll-like receptor (TLR)4 and its downstream target proteins TRIF and MyD88. The protection by pinocembrin was lost in microglia-depleted mice and in TLR4lps-del mice, and pinocembrin failed to decrease the number of M1-like microglia in TLR4lps-del mice. In lipopolysaccharide-stimulated BV-2 cells or primary microglia, pinocembrin decreased M1-related cytokines and markers (IL-1β, IL-6, TNF-α, and iNOS), NF-κB activation, and TLR4 expression, but it did not interfere with TLR4/MyD88 and TLR4/TRIF interactions or affect microglial phagocytosis of red blood cells. Inhibition of the TLR4 signaling pathway and reduction in M1-like microglial polarization might be the major mechanism by which pinocembrin protects hemorrhagic brain. With anti-inflammatory properties, pinocembrin could be a promising new drug candidate for treating ICH and other acute brain injuries.

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“…According to the guideline released by the AHA and the ASA [ 3 ], statin therapy is useful for stroke secondary prevention, especially for stroke survivors with high LDL cholesterol levels; that statin therapy could reduce their risk by at least 50%. However, evidence is still insufficient for clinical practice in that the guideline is initially based on secondary data analysis from the SPARCL trial [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…American Heart Association (AHA) and American Stroke Association (ASA) released updated guidelines for recurrent stroke prevention in people with a previous stroke and TIA. They recommended that statin therapy could reduce the risk of cardiovascular and cerebrovascular events [ 3 ]. Also, a current meta-analysis study [ 4 ] included randomized controlled trials (RCTs) from 1995 to 2016 and reported that statin therapy was related to a reducing tendency in the absolute risk of stroke recurrence for IS patients.…”

Section: Introductionmentioning

confidence: 99%

Statin Therapy for Preventing Recurrent Stroke in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohort Studies

et al. 2022

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Introduction: Statins are effective in preventing vascular disease and are widely recommended and used for the secondary prevention of ischemic stroke. However, there is concern from trials that statins might increase the risk of hemorrhagic stroke, partially reducing their benefit. We sought to systematically review the latest evidence on this question. Methods: Four electronic databases were searched to identify published randomized controlled trials (RCTs) and observational cohort studies (search date December 2020). Two independent reviewers carried out the eligibility assessment based on predefined inclusion criteria. We examined the outcomes of recurrent stroke (after ischemic stroke) of any type, and separately recurrent ischemic stroke and recurrent hemorrhagic stroke. RCTs and observational cohort studies were meta-analyzed separately. Odds ratios (ORs) were used to assess the effect of statin therapy. Meta-analysis was conducted using RevMan 5.4 software. Results: We retrieved 559 papers in searches, of which 11 RCTs and 12 observational cohort studies were included. Both RCTs and observational studies found that statins reduced the odds of stroke of any type in those with an initial ischemic stroke (11 RCTs: OR = 0.87, 95% CI [0.77,0.97]; p = 0.02; 12 cohort studies: OR = 0.80, 95% CI [0.66, 0.96]; p = 0.02). Both RCTs and observational studies found that recurrence of ischemic stroke was reduced by statins (6 RCTs: OR = 0.81, 95% CI [0.70, 0.93]; p = 0.002; 3 observational studies: OR = 0.67, 95% CI [0.61, 0.75]; p < 0.00001). Data from 7 RCTs and 8 cohort studies did not find a significant difference in hemorrhagic stroke but could not rule out a substantial increase or reduction (7 RCTs: OR = 1.15, 95% CI [0.62, 2.13]; p = 0.66; 8 cohort studies: OR = 0.93, 95% CI [0.71, 1.21]; p = 0.59). Conclusions: In people who have experienced an ischemic stroke, statins reduce the risk of recurrent stroke of any type medicated through a reduction of ischemic stroke. We found no increase in the risk of hemorrhagic stroke.

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Regarding Article “Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association”

Cited by 143 publications

References 3 publications

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Pinocembrin protects hemorrhagic brain primarily by inhibiting toll-like receptor 4 and reducing M1 phenotype microglia

Statin Therapy for Preventing Recurrent Stroke in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohort Studies

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Regarding Article “Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association”

Cited by 143 publications

References 3 publications

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA2DS2‐VASc Score of 1

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA2DS2‐VASc Score of 1

Pinocembrin protects hemorrhagic brain primarily by inhibiting toll-like receptor 4 and reducing M1 phenotype microglia

Statin Therapy for Preventing Recurrent Stroke in Patients with Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials and Observational Cohort Studies

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Product

Resources

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Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1

Refinement of Ischemic Stroke Risk in Patients with Atrial Fibrillation and CHA₂DS₂‐VASc Score of 1