The efficacy and safety of high-dose statins in acute phase of ischemic stroke and transient ischemic attack: a systematic review

Abstract

Inconsistent findings in the studies have been observed concerning the higher dose of statins use in the acute phase of ischemic stroke and transient ischemic attack (TIA). Therefore, we performed a systematic review to assess this issue. A computerized literature search in PubMed, Cochrane Library databases, and EMBASE for randomized controlled trials (RCTs) was conducted. The efficacy outcome indicators were National Institutes of Health Stroke Scale (NIHSS) score, infarct volume, and recurrence of stroke; the safety outcome indicators were intracranial hemorrhage events, cardiovascular and cerebrovascular events, and all-cause death. Pre-specified subgroup analyses were carried out. A total of seven RCTs with 1089 patients were included. Six studies reported the results of the NHISS score. A great reduction was found in NIHSS score in the statins group, and the difference is statistically significant [mean difference (MD) -1.15, 95% confidence interval (CI) -1.64 to -0.66, P < 0.00001]. However, no significant differences in the effect on recurrence of stroke [odds ratio (OR) 1.05, 95% CI 0.65-1.69, P = 0.85] (available in 3 studies), infarct volume [std. mean difference (SMD) 0.04, 95% CI -0.55 to 0.63, P = 0.89] (available in 2 studies), intracerebral hemorrhage events (OR 3.25, 95% CI 0.34-31.52, P = 0.31) (available in 2 studies), cardiovascular and cerebrovascular events (OR 0.70, 95% CI 0.35-1.43, P = 0.33) (available in 2 studies), and all-cause death (OR 1.18, 95% CI 0.60-2.35, P = 0.63) (available in 2 studies) were found. High-dose statin therapy in the acute phase of ischemic stroke and TIA significantly reduce the NIHSS score and improve short-term functional outcome without increasing related adverse events.

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.…”

“…Findings reveal that statins reduce the risk of first and recurrent ischemic strokes [4,5] and may also improve treatment outcomes through pleiotropic non-statin-associated effects [6]. Several studies [7][8][9][10][11][12] report the relationship between statin use and stroke, including related treatment outcomes. While some studies [13][14][15] report contradictory evidence that cholesterol reducers, including statins, do not reduce initial stroke severity, other studies [16][17][18] report favorable outcomes associated with statin use and stroke.…”

Effect of Simvastatin in Serum Interleukin-6 Level in Patients with Acute Ischemic Stroke

“…Similarly, a recent study shows that more aggressively statin therapy is associated with better long-term functional outcomes of the patients with acute ischemic stroke rather than less aggressive statin therapy (Fang, et al, 2017).…”

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

“…Findings reveal that statins reduce the risk of first and recurrent ischemic strokes [4,5] and may also improve treatment outcomes through pleiotropic nonstatin-associated effects [6]. Several studies [7][8][9][10][11][12] report the relationship between statin use and stroke, including related treatment outcomes. While some studies [13][14][15] report contradictory evidence that cholesterol reducers, including statins, do not reduce initial stroke severity, other studies [16][17][18] report favorable outcomes associated with statin use and stroke.…”