Rising statin use and effect on ischemic stroke outcome

Yoon, Sung Sug; Dambrosia, James; Chalela, Julio A.; Ezzeddine, Mustapha A.; Warach, Steven; Haymore, Joseph; Davis, Lisa; Baird, Alison E.

doi:10.1186/1741-7015-2-4

Cited by 68 publications

(66 citation statements)

References 38 publications

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“…Another small prospective trial in which consecutive patients with acute ischemic stroke were included that favorable outcome at 3 months (modified Rankin score) was independently associated with prior statin use in addition to age and National Institutes of Health Stroke Scale (NIHSS) score at admission (Marti-Fabregas et al, 2004). Similarly, in an observational study, Yoon et al (2004) found that patients with acute ischemic stroke that were taking statins at the time of admission had good outome 51% in compared with only 38% of patients not taking statins. The Heart and Estrogen-Progestin Replacement Study (HERS) showed a trend for a reduced number of fatal strokes with statin use (hazard ratio 0.52, 95% confidence interval 0.23 to 1.18; Bushnell et al, 2004).…”

Section: Direct Neuroprotective Effectsmentioning

confidence: 99%

Statins and Stroke

Endres

2005

J Cereb Blood Flow Metab

161

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: Direct Neuroprotective Effectsmentioning

confidence: 99%

Statins and Stroke

Endres

2005

J Cereb Blood Flow Metab

161

110

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“…When we applied the more aggressive LDL-C target goals recommended in the more recent ATP III guidelines, we found an even higher rate of potential undertreatment among high-risk persons, as expected. With widening indications for statins, as per recent Food and Drug Administration labeling to include individuals with any evidence of cerebrovascular disease, and more recent studies suggesting that pretreatment with statins may result in lesser stroke severity, 18 and better functional outcomes after a stroke, 19 we evaluated the correlates of treatment with statins among ischemic stroke survivors regardless of ATP-defined risk status. As was shown, CAD patients tended to receive statin treatment more often, and statin therapy was more prevalent in the United States than in Canada.…”

Section: Table 3 Demographic and Clinical Information On High-risk Sumentioning

confidence: 99%

Statin treatment and adherence to national cholesterol guidelines after ischemic stroke

et al. 2006

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Abstract-Background: National cholesterol guidelines have defined high vascular risk individuals as those who could potentially benefit most from statin therapy. The authors aimed to determine the rate of statin use, its predictors, and the achievement of national guideline target lipid goals among ischemic stroke survivors. Methods: The authors abstracted data from the Vitamin Intervention for Stroke Prevention (VISP) study database from the United States and Canada to incorporate into algorithms for initiating statin therapy according to the National Cholesterol Education Program (NCEP) guidelines for high-risk individuals. The authors applied these algorithms to all study subjects. Univariate as well as multivariate associations for target lipid levels and statin implementation were then evaluated utilizing pertinent demographic, clinical, and laboratory data. Results: Of 2,894 subjects in the analysis dataset, 38% were women; 71% were recruited in the United States and 29% in Canada. Of 769 high-risk subjects, 262 (34%) had a low-density lipoprotein (LDL) level Ն130 mg/dL and 124 of these (47%) were not on statin. Among those high-risk persons on statin treatment, only 42% had an LDL Յ100 mg/dL. Subjects in the overall cohort were more likely to be on a statin if they were treated in the United States or had a history of hypertension or coronary artery disease. Conclusions: Approximately one out of three guideline-eligible high vascular risk ischemic stroke patients in this study had low-density lipoprotein cholesterol concentrations above qualifying levels for pharmacologic therapy, but half of these patients were not taking a statin, and of those receiving statin treatment, less than half were within recommended lipid goals.

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“…decreasing incidence of cortical infarcts). Indeed, statin (HMG-coA reductase inhibitor) and fibrates decrease the CRP levels, and favorable outcome among ischemic stroke patients pretreated with statin was recently reported [36,37]. Further investigations are warranted to elucidate the effects of these agents as a potential stroke phenotype modifier.…”

Section: Discussionmentioning

confidence: 99%