Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

Abstract

Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS. Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009). Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

Statin Effects in Atrial Fibrillation-Related Stroke: A Systematic Review and Meta-Analysis

“…All of these publications were observational studies, and they included 12,216 subjects. Six studies were performed using a single-center or multicenter hospital-based registry on acute ischemic stroke ( 6 , 12 , 14 , 19 – 21 ). The other two studies were population-based ( 13 , 18 ).…”

“…Three studies were used in our meta-analysis for poor functional outcomes ( 19 – 21 ). Pre-stroke statin therapy was associated with a reduced risk of poor functional outcomes (OR, 0.63; 95% CI, 0.47–0.85) with moderate heterogeneity ( I 2 = 33%) ( Figure 2E ).…”

“…Pre-stroke statin therapy was associated with a reduced risk of poor functional outcomes (OR, 0.63; 95% CI, 0.47–0.85) with moderate heterogeneity ( I 2 = 33%) ( Figure 2E ). Among the included studies, only the study by He et al ( 19 ) adjusted the type of AF. Although a meta-analysis was not conducted, the study by He et al ( 19 ) showed that pre-stroke statin was inversely associated with the 3-month mortality (OR, 0.38; 95% CI, 0.16–0.91).…”

“…Among the included studies, only the study by He et al ( 19 ) adjusted the type of AF. Although a meta-analysis was not conducted, the study by He et al ( 19 ) showed that pre-stroke statin was inversely associated with the 3-month mortality (OR, 0.38; 95% CI, 0.16–0.91). We did not perform subgroup and sensitivity analyses owing to the limited number of studies included.…”

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

“…Treatment with statins before or early after an ischemic stroke is reported to trigger favorable outcomes [9] through its pleiotropic effects, such as endothelial nitric oxide increase [67], reduction of oxidative stress [68], inhibition of platelet activation [69], and anti-inflammatory activities [70]. These properties suggest statins as a safe and promising pre-or cotreatment with rtPA for an effective reperfusion therapy in the acute phase of stroke [7,71], However, these benefits are not attributed to a statin's cholesterol lowering effects but are associated with its other pleiotropic effects.…”