BACKGROUND: HMG-CoA-reductase (statin) therapy to reduce low-density lipoprotein cholesterol (LDL-C) levels in patients with coronary heart disease can substantially improve outcomes; however, the benefits of statins in stroke patients, particularly for secondary stroke prevention, remain poorly understood. Moreover, the degree of decrease in LDL-C that is required to prevent the recurrence of stroke is unknown. OBJECTIVE: To determine whether the on-treatment LDL-C/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) is a predictive marker of stroke recurrence in patients with acute ischaemic stroke, and whether medical management of the LDL-C/HDL-C ratio would be of strategic significance for stroke prevention. METHODS: A total of 137 dyslipidaemic patients who had suffered acute ischaemic stroke were enrolled and treated with rosuvastatin 2.5 mg within 24 hours of onset. Blood pressure and serum lipids were assessed at baseline and after 1 month of treatment with rosuvastatin. Fatal and non-fatal stroke events were recorded during a follow-up period of 36 months. We used univariate and multivariate analyses, as well as Kaplan-Meier analysis, to assess the predictive value of various parameters and to identify factors independently associated with stroke recurrence. RESULTS: During a mean follow-up of 34.9 ± 0.8 months, there were ten cases of stroke recurrence. Age, chronic kidney disease (CKD) at baseline, and an on-treatment LDL-C/HDL-C ratio >2 after 1 month of rosuvastatin treatment were predictors of stroke recurrence in univariate analyses. Stepwise regression analysis showed that CKD (standardized adjusted odds ratio [OR] 6.55; 95% confidence interval [CI] 1.12, 36.43; p = 0.030) and on-treatment LDL-C/HDL-C ratio >2 (standardized adjusted OR 9.70; 95% CI 1.70, 55.33; p = 0.011) were independent risk factors for stroke recurrence. Post hoc analysis indicated that more intensive lipid control, to an LDL-C/HDL-C ratio ≤1.5, may reduce the risk of stroke recurrence. CONCLUSION: These results suggest that the use of statin therapy to achieve an on-treatment LDL-C/HDL-C ratio ≤2 is a suitable treatment strategy in patients having suffered acute ischaemic stroke. Further studies are required to confirm the clinical benefits of reducing the on-treatment LDL-C/HDL-C ratio to ≤1.5.
BACKGROUND: HMG-CoA-reductase (statin) therapy to reduce low-density lipoprotein cholesterol (LDL-C) levels in patients with coronary heart disease can substantially improve outcomes; however, the benefits of statins in strokepatients, particularly for secondary stroke prevention, remain poorly understood. Moreover, the degree of decrease in LDL-C that is required to prevent the recurrence of stroke is unknown. OBJECTIVE: To determine whether the on-treatment LDL-C/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) is a predictive marker of stroke recurrence in patients with acute ischaemic stroke, and whether medical management of the LDL-C/HDL-C ratio would be of strategic significance for stroke prevention. METHODS: A total of 137 dyslipidaemic patients who had suffered acute ischaemic stroke were enrolled and treated with rosuvastatin 2.5 mg within 24 hours of onset. Blood pressure and serum lipids were assessed at baseline and after 1 month of treatment with rosuvastatin. Fatal and non-fatal stroke events were recorded during a follow-up period of 36 months. We used univariate and multivariate analyses, as well as Kaplan-Meier analysis, to assess the predictive value of various parameters and to identify factors independently associated with stroke recurrence. RESULTS: During a mean follow-up of 34.9 ± 0.8 months, there were ten cases of stroke recurrence. Age, chronic kidney disease (CKD) at baseline, and an on-treatment LDL-C/HDL-C ratio >2 after 1 month of rosuvastatin treatment were predictors of stroke recurrence in univariate analyses. Stepwise regression analysis showed that CKD (standardized adjusted odds ratio [OR] 6.55; 95% confidence interval [CI] 1.12, 36.43; p = 0.030) and on-treatment LDL-C/HDL-C ratio >2 (standardized adjusted OR 9.70; 95% CI 1.70, 55.33; p = 0.011) were independent risk factors for stroke recurrence. Post hoc analysis indicated that more intensive lipid control, to an LDL-C/HDL-C ratio ≤1.5, may reduce the risk of stroke recurrence. CONCLUSION: These results suggest that the use of statin therapy to achieve an on-treatment LDL-C/HDL-C ratio ≤2 is a suitable treatment strategy in patients having suffered acute ischaemic stroke. Further studies are required to confirm the clinical benefits of reducing the on-treatment LDL-C/HDL-C ratio to ≤1.5.
Authors: Peter S Sever; Björn Dahlöf; Neil R Poulter; Hans Wedel; Gareth Beevers; Mark Caulfield; Rory Collins; Sverre E Kjeldsen; Arni Kristinsson; Gordon T McInnes; Jesper Mehlsen; Markku Nieminen; Eoin O'Brien; Jan Ostergren Journal: Lancet Date: 2003-04-05 Impact factor: 79.321
Authors: O Y Bang; J L Saver; D S Liebeskind; S Starkman; P Villablanca; N Salamon; B Buck; L Ali; L Restrepo; F Vinuela; G Duckwiler; R Jahan; T Razinia; B Ovbiagele Journal: Neurology Date: 2006-12-20 Impact factor: 9.910
Authors: John C LaRosa; Scott M Grundy; David D Waters; Charles Shear; Philip Barter; Jean-Charles Fruchart; Antonio M Gotto; Heiner Greten; John J P Kastelein; James Shepherd; Nanette K Wenger Journal: N Engl J Med Date: 2005-03-08 Impact factor: 91.245
Authors: Pierre Amarenco; Larry B Goldstein; Michael Szarek; Henrik Sillesen; Amy E Rudolph; Alfred Callahan; Michael Hennerici; Lisa Simunovic; Justin A Zivin; K Michael A Welch Journal: Stroke Date: 2007-10-25 Impact factor: 7.914
Authors: Binh An P Phan; Baocheng Chu; Nayak Polissar; Thomas S Hatsukami; Chun Yuan; Xue-Qiao Zhao Journal: Int J Cardiovasc Imaging Date: 2006-11-04 Impact factor: 2.316