Statins in Stroke Prevention and Carotid Atherosclerosis

Amarenco, Pierre; Labreuche, Julien; Lavallée, Philippa C.; Touboul, Pierre‐Jean

doi:10.1161/01.str.0000147965.52712.fa

Cited by 689 publications

(491 citation statements)

References 73 publications

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“…In the present study, both longitudinal and cross-sectional analyses convincingly excluded CHD and microvascular disease from the causal pathway for depression, whereas CVD was implicated in the cross-sectional study. Second, there is increasingly strong evidence that elevated cholesterol levels are an independent risk factor for ischaemic stroke [42]. Finally, it is known that disability is a risk factor for depressive disorders [43] and we have demonstrated that both stroke and PAD are important predictors of ADL disability in diabetes [28].…”

Section: Discussionmentioning

confidence: 72%

Vascular depression in older people with diabetes

et al. 2006

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Aims/hypothesis Cerebrovascular disease may be causal or a vulnerability factor in late-onset depression and may explain the high rate of depression in older adults with diabetes. We explored a wide range of potential explanatory variables of depression in a longitudinal study of older diabetic subjects to investigate the vascular depression hypothesis in these patients. Methods We recruited 207 subjects with diabetes selected for potential cognitive deficits from an existing observational cohort study (average age 75.7±4.6 years, 52.2% men) for an assessment of depression using a standardised diagnostic instrument (Cambridge Examination for Mental Disorders of the Elderly -Revised). All subjects underwent a detailed clinical assessment at baseline and at follow-up (after 7.5± 1.1 years). Results Major depression was present in 45 subjects (21.7%) and minor depression in ten (4.8%). A positive history of strokes and the presence of peripheral arterial disease were significantly associated with depression at the time of diagnosis. In a subsample of 93 cases who underwent structural neuroimaging, the presence of cerebral infarcts was also significantly associated with depression. Treatment with glucose-lowering therapy, higher serum cholesterol levels and difficulties with activities of daily living at baseline were significant predictors of depression at follow-up. Conclusions/interpretation A history of cerebrovascular disease was strongly associated with depression and cerebrovascular risk factors were significant predictors of depression in older diabetic patients. Our findings are consistent with the hypothesis that the excess risk of depression in older diabetic patients is related to underlying cerebrovascular disease.

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Section: Discussionmentioning

confidence: 72%

Vascular depression in older people with diabetes

et al. 2006

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“…Significant or nearly significant risk reduction of CVD was found for LDL-C 133.4 mg/dL, non-HDL-C 160.8 mg/dL, and LDL-C/ HDL-C ratio 2.0. The benefit of statin therapy against CVD has been well established by numerous large-scale studies [21][22][23][24][25][26][27][28][29] and meta-analyses 30,31) that have also suggested LDL-C target levels used by current guidelines and showed that non-HDL-C and LDL-C/HDL-C are associated with CVD risk. The ATP guidelines 3) state that non-HDL-C is a secondary target, and the level is set by adding 30 mg/dL to LDL-C target levels ( 130 mg/dL for moderate/ moderately high risk, 160 mg/dL for low risk).…”

Section: Discussionmentioning

confidence: 99%

Usefulness of LDL-C-Related Parameters to Predict Cardiovascular Risk and Effect of Pravastatin in Mild-to-Moderate Hypercholesterolemia

Mizuno¹,

Nakaya²,

Teramoto

et al. 2012

JAT

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Aim: Low-density lipoprotein cholesterol (LDL-C), the ratio of LDL-C to high-density lipoprotein cholesterol (HDL-C; LDL-C/HDL-C), and non-HDL-C were evaluated to determine their ability to predict cardiovascular disease (CVD) risk with pravastatin treatment. Methods: We conducted a large-scale randomized primary prevention trial in Japan (MEGA Study), in which we randomly allocated 7832 mild hypercholesterolemic patients to diet alone (n 3966) and diet plus pravastatin groups (n 3866) and followed them for an average of 5 years. We compared baseline levels and the CVD incidence in the diet alone group, and time-dependent receiver operating characteristic curves in the overall population. To determine the best parameter for predicting the efficacy of pravastatin, the diet plus pravastatin group was divided into tertiles to compare lipid parameters and CVD incidence versus the diet alone group. Results: Significantly graded correlations were found between CVD and LDL-C/HDL-C and non-HDL-C. Significantly more CVD events were associated with LDL-C/HDL-C 186 mg/dL and LDL-C/HDL-C 2.9. Furthermore, LDL-C/HDL-C or non-HDL-C was more predictive than LDL-C. By measuring LDL-C/HDL-C or non-HDL-C, we allocated 32% of the diet plus pravastatin group into a different risk category. The lowest significant incidence of CVD was found in patients with LDL-C 119.8-133.4 mg/dL, LDL-C/HDL-C 1.9, and non-HDL-C 145.2-160.8 mg/dL. Conclusion: Non-HDL-C and LDL-C/HDL-C have a greater ability to predict CVD risk in mild-tomoderate hypercholesterolemic Japanese individuals than LDL-C, and are more useful to evaluate the effect of pravastatin; however, these parameters should be interpreted independently when assessing CVD risk.

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“…Large randomized trials have demonstrated that statins significantly reduce the risk of MI and cardiovascular mortality [27][28][29][30][31], with a magnitude that is greater than expected based on LDL-C reduction alone. In addition, meta-analyses suggest that statins may reduce the risk of stroke to a greater extent than expected based on cholesterol lowering, and more than non-statin lipid lowering therapy [32][33][34]. This suggests that other factors, such as statin-induced hsCRP reduction, may have a role to play in reducing cardiovascular events.…”

Section: Discussionmentioning

confidence: 99%

Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

Gensini¹,

Gori²,

Dilaghi³

et al. 2010

International Journal of Cardiology

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Background: Elevated C-reactive protein (CRP) concentration is a risk factor for cardiovascular events that may add prognostic information. Statin treatment is associated with significant reductions in CRP concentrations, which appear to be unrelated to the magnitude of LDL-cholesterol reduction. We investigated the effect of atorvastatin, across its dose range, on high sensitivity (hs)CRP in subjects at high cardiovascular risk. Methods: ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned a starting dose of atorvastatin (10,20,40 Results: At baseline, ST subjects had significantly lower hsCRP levels than SF subjects (ST group 2.31, 95% CI 2.15, 2.48 mg/L vs. SF group 3.16, 95% CI 2.98, 3.34 mg/L, p b 0.05). In the SF group, atorvastatin 10 to 80 mg significantly (p b 0.01) reduced hsCRP levels in a dose dependent-manner. In ST group, additional hsCRP reductions were observed over the statin used at baseline, which were not dosedependent. Atorvastatin significantly decreased hsCRP concentrations in subjects with or without diabetes or the metabolic syndrome. Conclusions: Atorvastatin treatment at different doses, particularly 80 mg, significantly reduced hsCRP serum concentrations. This reduction was observed in both SF and ST groups and was independent of the presence of metabolic syndrome and/or diabetes. The beneficial effect of atorvastatin was evident at 6 weeks, supporting the practice of early introduction of higher doses of atorvastatin in high-risk patients.

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Statins in Stroke Prevention and Carotid Atherosclerosis

Cited by 689 publications

References 73 publications

Vascular depression in older people with diabetes

Vascular depression in older people with diabetes

Usefulness of LDL-C-Related Parameters to Predict Cardiovascular Risk and Effect of Pravastatin in Mild-to-Moderate Hypercholesterolemia

Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

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