Atorvastatin reduces cerebral vasospasm and infarction after aneurysmal subarachnoid hemorrhage in elderly Chinese adults

Abstract

We explored whether acute atorvastatin treatment would improve clinical outcomes and reduce the incidence of cerebral vasospasm after aneurysmal subarachnoid hemorrhage in elderly Chinese adults. Patients (60 to 90 years old) were admitted to intensive care units after surgery to clip or embolize their aneurysms. We assessed 592 patients and assigned 159 to receive atorvastatin (20 mg/day) and 158 to receive placebo once daily for up to 14 days. The primary outcome was the Glasgow outcome scale at 6 months, and secondary outcomes were cerebral vasospasm, 30-days all-cause mortality, cerebral infarction, and delayed ischemic neurological deficit. The incidence of postoperative cerebral vasospasm (39.3% vs 56%, P =0.004) and cerebral infarction (18.7% vs 27.3%, P=0.027) were significantly lower in the atorvastatin group. The study did not detect benefits in the use of atorvastatin for 6 months clinical outcome or 30-day all-cause mortality, but it suggests that atorvastatin together with nimodipine can reduce cerebral vasospasm and cerebral infarction after subarachnoid hemorrhage.

Atorvastatin ameliorates early brain injury after subarachnoid hemorrhage via inhibition of pyroptosis and neuroinflammation

“…Early brain injury (EBI) and cerebral vasospasm (CVS) were the main reasons to contribute to the poor outcome of SAH patients. But, recent clinical trials confirmed that medications can significantly ameliorate CVS but have no effect on outcomes after SAH (Macdonald et al, 2011), and our previous clinical study also demonstrated it too (J. Chen, Li, et al, 2020). More recent studies had shown that EBI after SAH seems to play a very important role after SAH (Chen et al, 2019; Chen, Li, et al, 2020; Chen et al, 2018; Chen et al, 2016).…”

“…But, recent clinical trials confirmed that medications can significantly ameliorate CVS but have no effect on outcomes after SAH (Macdonald et al, 2011), and our previous clinical study also demonstrated it too (J. Chen, Li, et al, 2020). More recent studies had shown that EBI after SAH seems to play a very important role after SAH (Chen et al, 2019; Chen, Li, et al, 2020; Chen et al, 2018; Chen et al, 2016). The possible mechanisms underlying EBI include autophagy, apoptosis, direct neuronal death, and necroptosis (Cahill & Zhang, 2009; Chen, Li, et al, 2020; Dong et al, 2016; Kenny et al, 2019).…”

Effects of Perioperative Rosuvastatin for Postoperative Delirium After Elderly General Anesthesia Patients: A Randomized, Double-Blind, and Placebo-Controlled Trial

“…Inclusion criteria were as follows: (1) Aged more than 60 years; (2) Could be randomized and received rosuvastatin or placebo within 10 days perioperative; and (3) under general anesthesia and were admitted to the ICU. Exclusion criteria were as follows: (1) Unsalvageable patients likely on admission; (2) High cholesterol combined with diabetes; (3) Brain injury or neurosurgery; (4) Severe sinus bradycardia; (5) Neurologic disease; (6) Abnormal liver enzymes, patients with rhabdomyolysis, and myopathy; (7 Patients with a history of mental illness and epilepsy; (8) Patients with severe lung disease and multiple organ dysfunction; and (9) Researchers found other reasons.…”

“…Statins, as inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, are widely used in cardiovascular disorders as cholesterol-lowering medications. Recent studies had indicated that statins have been proven to exert pleiotropic effects, including anti-inflammatory, antioxidative stress, inhibit platelet aggregation, and neuroprotection [7][8][9][10]. As the neuroprotection related molecular mechanism was similar to the delirium, so it indicated that statins may prevent delirium.…”

Association Between Circular RNAs and Intracranial Aneurysm Rupture Under the Synergistic Effect of Individual Environmental Factors

“…The annual incidence of IA rupture worldwide is about 9.1 per 100,000, accounting for 3 to 5% of all acute strokes. The age of onset is between 40 and 60 years old, the mortality rate is close to 40%, and 46% of survivors can be disabled or long-term cognitive impairment due to multiple complications (2)(3)(4)(5). Therefore, it is called the "time bomb" in the brain, which seriously threatens human life and health (6).…”