Treatment with statins and ischemic stroke severity

Martínez-Sánchez, Patricia; Fuentes, Blanca; Martínez-Martínez, Marta; Ruíz-Ares, Gerardo; Fernández-Travieso, J; Sanz-Cuesta, Borja Enrique; Cuéllar-Gamboa, Lorena; Díaz-Domínguez, Elena; Díez‐Tejedor, Exuperio

doi:10.1212/wnl.0b013e3182918d38

Cited by 32 publications

(27 citation statements)

References 19 publications

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“…Interestingly, a recent study showed an association of pretreatment with statins and mild stroke severity on admission, which was pronounced in patients with high-dose statin therapy. 22 A part of the observed effects in our study might be explained by lower cholesterol levels in statin users. Lower cholesterol has been identified as a risk factor for ICH and has been linked to hemorrhagic transformation in the setting of thrombolysis.…”

Section: Discussionmentioning

confidence: 67%

“…Patients were excluded for missing data about statin use or dose (n=6) or lacking information about sICH (n=3). The Berlin cohort consisted of 781 patients (median age, 75; median NIHSS score, 10; previous statin use, 22.4%; sICH rate, 3.9%; favorable outcome, 46.8%) and the Basel cohort consisted of 660 patients (median age, 74; median NIHSS score, 12; previous statin use, 21.4%; sICH rate, 3.3%; favorable outcome, 58.9%). Overall, the median age of the study population was 75 years, and the median NIHSS score was 11.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Scheitz

Seiffge

Tütüncü³

et al. 2014

Stroke

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H MG-CoA reductase inhibitors (ie, statins) constitute a cornerstone in primary and secondary prevention of ischemic stroke.1 In addition to dose-dependent cholesterol-lowering effects, statins have dose-dependent pleiotropic effects, including antithrombotic properties, and were shown to modify fibrinolytic balance toward a more profibrinolytic state.2 These properties may contribute to the beneficial impact of statins on outcome after ischemic stroke, which was recently confirmed in a large meta-analysis. 3 However, studies on patients receiving intravenous thrombolysis (IVT) reported conflicting results, and the effects on outcome seemed to be attenuated. [3][4][5] Rather, there has been a discussion that patients with previous statin use might be more likely to develop symptomatic intracerebral hemorrhage (sICH) after IVT. [5][6][7] A recently published meta-analysis showed a positive association of statins with IVT-related sICH, but the statistical significance was lost if only studies with adjusted analyses were included. 5Previous studies investigating the impact of statins on outcome and sICH after IVT lacked information about statin dose. Using pooled data from 2 large European thrombolysis registries, we aimed to analyze the effects of statin dose on risk of sICH and outcome after IVT.Background and Purpose-The aim of our study was to assess whether statins have dose-dependent effects on risk of symptomatic intracerebral hemorrhage (sICH) and outcome after intravenous thrombolysis for ischemic stroke. Methods-We pooled data from 2 European intravenous thrombolysis registries. Statin doses were stratified in 3 groups according to the attainable lowering of cholesterol levels (low dose: simvastatin 20 mg or equivalent; medium dose: simvastatin 40 mg or equivalent; and high dose: simvastatin 80 mg or equivalent). sICH was defined according to the European Cooperative Acute Stroke Study. Modified Rankin Scale score 0 to 2 at 3 months was considered a favorable outcome. Results-Among 1446 patients analyzed (median age, 75 years; median initial National Institutes of Health Stroke Scale score, 11; 54% men), 317 (22%) used statins before intravenous thrombolysis. Of them, 120 patients had low-dose, 134 medium-dose, and 63 high-dose statin therapy. sICH occurred in 4% of patients (n=53). Frequency of sICH was 2%, 6%, and 13% in patients with low-, medium-, and high-dose statin treatment, respectively (P<0.01). Adjusted odds ratio (OR) for sICH was 2. 4,9,10 All patients were treated in a specialized stroke unit for ≥24 hours. The registries were approved by the respective ethics committees.Baseline characteristics, including age, sex, and medical history (atrial fibrillation, coronary artery disease, current smoking, diabetes mellitus, hypertension, and previous stroke), were collected. Stroke severity was assessed via the National Institutes of Health Stroke Scale (NIHSS) by certified raters. Moreover, onsetto-treatment time and blood pressure on admission were recorded. Laboratory measures included glucose l...

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Section: Discussionmentioning

confidence: 67%

Section: Resultsmentioning

confidence: 99%

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Scheitz

Seiffge

Tütüncü³

et al. 2014

Stroke

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“…Even in hemorrhagic stroke data from recent studies suggest that statin therapy could improve the outcome after spontaneous intra-cerebral hemorrhage and statin therapy should be not discontinued [66][67][68][69]. Pre-treatment with statins is associated with lower stroke severity, at high as well as at low to moderate doses [70]. Other data suggest that we cannot draw any conclusion about the effectiveness and safety of lowering cholesterol in aneurismal SAH because insufficient reliable evidence from trials [71].…”

Section: Strokementioning

confidence: 99%

Statins in neurological disorders: An overview and update

Malfitano

Marasco

Proto

et al. 2014

Pharmacological Research

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“…Because initial neurological severity is a significant determinant of functional outcome after ischemic stroke [6], it is also of clinical interest to determine whether pre-stroke statin management influences neurological severity and functional outcome after ischemic stroke. However, although accumulated evidence suggests that patients already receiving statins are at an advantage in terms of a reduced neurological severity after ischemic stroke because of the immediate beneficial effects of statins, the effect of pre-stroke statin treatment on initial stroke severity and on functional outcome remains controversial, even among studies performing systematic reviews and meta-analyses of previous results [7,8,9,10,11,12,13,14,15,16,17,18,19,20]. Because most of the previous studies focused on the effect of pre-stroke statin treatment on functional outcome, potential confounding factors were not adjusted by multivariable analyses for the association between pre-stroke statin treatment and initial stroke severity [7,8,11,13,15,16,17].…”

Section: Introductionmentioning

confidence: 99%

“…Because most of the previous studies focused on the effect of pre-stroke statin treatment on functional outcome, potential confounding factors were not adjusted by multivariable analyses for the association between pre-stroke statin treatment and initial stroke severity [7,8,11,13,15,16,17]. Previous studies were also limited by a small sample size [7,8,9,11,12,14], a single center-based setting [9,12,13,16,17], or including patients with premorbid neurological dysfunction for the study participants [8,9,10,12,14,15,16], which may have contributed to the conflicting results.…”

Section: Introductionmentioning

confidence: 99%

Influence of Statin Pretreatment on Initial Neurological Severity and Short-Term Functional Outcome in Acute Ischemic Stroke Patients: The Fukuoka Stroke Registry

Ishikawa

Wakisaka²,

Matsuo³

et al. 2016

Cerebrovasc Dis

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Background: Statins have neuroprotective effects against ischemic stroke. However, associations between pre-stroke statin treatment and initial stroke severity and between the treatment and functional outcome remain controversial. This study aimed at determining these associations in ischemic stroke patients. Methods: Among patients registered in the Fukuoka Stroke Registry from June 2007 to October 2014, 3,848 patients with ischemic stroke within 24 h of onset, who had been functionally independent before onset, were enrolled in this study. Ischemic stroke was classified as cardioembolic or non-cardioembolic infarction. Primary and secondary study outcomes were mild neurological symptoms defined as a National Institutes of Health Stroke Scale score of ≤4 on admission and favorable functional outcome defined as a modified Rankin Scale score of ≤2 at discharge, respectively. Multivariable logistic regression models were used to quantify associations between pre-stroke statin treatment and study outcomes. Results: Of all 3,848 participants, 697 (18.1%) were taking statins prior to the stroke. The frequency of mild neurological symptoms was significantly higher in patients with pre-stroke statin treatment (64.1%) than in those without the treatment (58.3%, p < 0.01). Multivariable analysis showed that pre-stroke statin treatment was significantly associated with mild neurological symptoms (OR 1.31; 95% CI 1.04-1.65; p < 0.01). Sensitivity analysis in patients with dyslipidemia (n = 1,998) also showed the same trend between pre-stroke statin treatment and mild neurological symptoms (multivariable-adjusted OR 1.26; 95% CI 0.99-1.62; p = 0.06). In contrast, the frequency of favorable functional outcome was not different between patients with (67.0%) and without (65.3%) the treatment (p = 0.40). Multivariable analysis also showed no significant association between pre-stroke statin treatment and favorable functional outcome (OR 1.21; 95% CI 0.91-1.60; p = 0.19). Continuation of statin treatment, however, was significantly associated with favorable functional outcome among patients with pre-stroke statin treatment (multivariable-adjusted OR 2.17; 95% CI 1.16-4.00; p = 0.02). Conclusions: Pre-stroke statin treatment in ischemic stroke patients was significantly associated with mild neurological symptoms within 24 h of onset. Pre-stroke statin treatment per se did not significantly influence the short-term functional outcome; however, continuation of statin treatment during the acute stage of stroke seems to relate with favorable functional outcome for patients with pre-stroke statin treatment.

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Treatment with statins and ischemic stroke severity

Abstract: Pretreatment with statins is associated with lower stroke severity, at high as well as at low to moderate doses.

Cited by 32 publications

References 19 publications

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Statins in neurological disorders: An overview and update

Influence of Statin Pretreatment on Initial Neurological Severity and Short-Term Functional Outcome in Acute Ischemic Stroke Patients: The Fukuoka Stroke Registry

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