Statins for Secondary Stroke Prevention in Patients without Known Coronary Heart Disease: The Jury Is Still Out

Goldstein, LB; Amarenco, Pierre; Bogousslavsky, Julien; As, Callahan; Mg, Hennerici; Km, Welch; Zivin, Justin A.; Sillesen, Henrik

doi:10.1159/000078600

Cited by 13 publications

(5 citation statements)

References 4 publications

(3 reference statements)

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“…Clinical further studies demonstrated that lovastatin not only regulated plasma lipids concentrations, but also improved inflammation response, such as enhances anti-inflammation effect in CVD [31][32][33]. Hs-CRP and MMP-9, two major inflammation markers, were elevated significantly in lovastatin treated patients of this study.…”

Section: Discussionsupporting

confidence: 49%

The effect of high-dose lovastatin therapy on patients with acute cerebral infarction

Guo¹,

Chen²,

Ye³

et al. 2017

Gastroenterol Hepatol Endosc

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Cerebrovascular disease (CVD) is the third most common cause of death worldwide and responsible for stroke and transient ischemic attack. This study aimed to investigate the clinical efficacy of high-dose lovastatin on patients with acute cerebral infarction. 150 patients with acute cerebral infarction were randomized divided into control group (n=50), 80 mg/d lovastatin (80 L) group (n=50) and 20 mg/d lovastatin (20 L) group (n=50). Control group, 80 L group and 20 L group received conventional treatment, conventional treatment together with lovastatin 80 mg/d and conventional treatment as well as lovastatin 20 mg/d respectively for 3 months. Biochemical indices, neurological deficit and plaque thickness and volume were assessed and recorded after treatment. After lovastatin treatment, the plasma levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL) were significantly decreased in 80 L group and 20 L group, and highdensity lipoprotein (HDL) were significantly increased in 80 L group and 20 L group (p<0.05). Moreover, lovastatin could also decrease MMP-9 and hs-CRP levels (p<0.05). Furthermore, improved neurological deficit were found in lovastatin treatment groups. In addition, lovastatin treatment also improved plaque states include plaque thickness and volume in 80 L group and 20 L group (p<0.05). What's more, high-dose lovastatin a better ability in regulated plasma lipid levels, inflammation, neurological deficit and plaque thickness and volume than low-dose of lovastatin. Lovastatin could improve acute cerebral infarction and high-dose lovastatin treatment was better than low-dose lovastatin treatment.

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Section: Discussionsupporting

confidence: 49%

The effect of high-dose lovastatin therapy on patients with acute cerebral infarction

Guo¹,

Chen²,

Ye³

et al. 2017

Gastroenterol Hepatol Endosc

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“…Total cholesterol, and LDL and HDL sub-fractions are established risk factors for coronary heart disease (CHD) but weak predictors of ischaemic stroke [1,2,3]. This difference may be due in part to the more heterogeneous pathogenesis of ischaemic stroke, differences in the effect of plasma lipids on atherogenesis between the coronary and other vascular beds, or the fact that stroke tends to occur at an older age.…”

Section: Introductionmentioning

confidence: 99%

Apolipoproteins as Predictors of Ischaemic Stroke in Patients with a Previous Transient Ischaemic Attack

Bhatia¹,

Howard²,

Clark

et al. 2006

Cerebrovasc Dis

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Background: Weak associations between total and LDL cholesterol and ischaemic stroke compared with coronary heart disease (CHD) are at odds with the similar effectiveness of statin drugs in preventing ischaemic stroke and CHD, suggesting that other lipid sub-fractions that are affected by statins might be better predictors of ischaemic stroke. Apolipoprotein B levels are reduced by statins and are a stronger predictor of CHD than total and LDL cholesterol in patients both on and off statins. However, there are very few published data on apolipoproteins and stroke risk and no studies in patients with previous transient ischaemic attack (TIA). Methods: We performed a prospective cohort study of the associations of baseline total cholesterol, LDL, HDL, apolipoproteins A1 and B (apo A1; apo B) and risk of ischaemic stroke in 261 patients with previous TIA. Cox proportional hazards models were used to determine crude and multivariate-adjusted hazard ratios (HR) above versus below median values at 10-years follow-up. Results: The apo B/apo A1 ratio was the strongest independent predictor of ischaemic stroke (HR = 2.94, 95% CI 1.43–5.88, p = 0.003) followed by apo B (HR = 2.26, 95% CI 1.16–4.38, p = 0.02). The associations between total cholesterol, LDL, HDL, LDL/HDL ratio and apo A1 and ischaemic stroke risk did not reach statistical significance. Conclusions: Apo B and the apo B/apo A1 ratio are predictive of ischaemic stroke in patients with previous TIA. Further studies are required to determine whether the prognostic value of apolipoprotein levels is maintained in patients on statins.

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“…Another explanation may be the larger reduction in LDL cholesterol in SPARCL (56 mg/dL [1.4 mmol/L] in SPARCL vs 39 mg/dL [1.0 mmol/L] in HPS). Other differences between the trials have been reviewed previously [9].…”

Section: Sparcl: Commentary On Main Resultsmentioning

confidence: 99%

“…A meta-analysis of 90,000 patients included in these previous statin trials showed that the reduction in stroke risk was primarily related to the extent of low-density lipoprotein (LDL) cholesterol lowering [8]. However, for a long time no data existed to show that statin treatment decreased the rate of recurrent stroke in patients with prior stroke or TIA [9,10]. Data have now emerged from the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study [11••] establishing that statin therapy is also benefi cial in the secondary prevention of stroke.…”

Section: Introductionmentioning

confidence: 99%

Review of the SPARCL trial and its subanalyses

Welch

2009

Curr Atheroscler Rep

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The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study is a prospective, randomized, placebo-controlled trial that was designed to determine whether 80 mg/d of atorvastatin reduced the risk of fatal or nonfatal stroke in patients who had previously experienced a stroke or transient ischemic attack. It is unique in that it is the only trial to study this cohort of patients with no known coronary heart disease. The review recaps the results of the primary SPARCL data and discusses the findings of subsequent analyses that extend the conclusions from the study. Atorvastatin reduced the risk of stroke to a clinically persuasive degree. This benefit was present despite a small increase in risk of intracerebral hemorrhage. Factors were identified in SPARCL that might reduce this risk if implemented. Further subanalyses addressed other questions relative to stroke profile of benefit and potential mechanisms of statin action. SPARCL has established that statins have an important role in secondary stroke prevention.

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Statins for Secondary Stroke Prevention in Patients without Known Coronary Heart Disease: The Jury Is Still Out

Cited by 13 publications

References 4 publications

The effect of high-dose lovastatin therapy on patients with acute cerebral infarction

The effect of high-dose lovastatin therapy on patients with acute cerebral infarction

Apolipoproteins as Predictors of Ischaemic Stroke in Patients with a Previous Transient Ischaemic Attack

Review of the SPARCL trial and its subanalyses

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