This case raises several questions: Irrespective of the etiology of ischemic stroke, use of statins has been associated with reduced infarct size and a more favorable outcome.
The benefits were more pronounced in statin-na fkve patients Atorvastatin Dose After Stroke received statins early on after the stroke as compared with patients on statins before stroke onset. Furthermore, the benefits Atorvastatin Dose After Stroke across all stroke types including cardioembolic stroke. Hyperlipidemia was not a predictor of outcome and the authors found the small lipid-lowering effect to be out of proportion to the significantly improved acute ischemic stroke outcomes, stressing the importance of the pleiotropic effects of statins.
The Dublin study, here largest to date, addressed 3 important questions: A benefit of statins given prestroke as well as after stroke onset was seen with a greater magnitude effect with poststroke statins.
Their study also reconfirmed that higher doses of statins were associated with better outcomes atorvastatin at 40 mg being better than 20 mg, which in turn was better than 10 mg. Interestingly enough, even 10 mg did show a benefit but not of the same magnitude as here higher doses.
This is not surprising given the growing realization that although being risk factors for ischemic stroke, neither total cholesterol or low-density lipoprotein cholesterol is associated with outcome of acute ischemic stroke and that the many pleiotropic effects of statins are perhaps more important at least in the first 3 to 7 days after stroke.
Among the most relevant pleiotropic effects are dose-dependent elevation of endothelial nitric oxide synthetase, which in turn regulates the endothelial tone and laminar flow.
Statins also enhance endogenous tissue-type plasminogen activator, exert an antithrombotic effect, improve collateral blood flow, and reduce inflammatory mediators. Collectively, these dose-dependent effects of statins improve blood flow to the penumbra and help with autolysis of clots, reduce the chances of reocclusion, reduce the infarct size, and improve clinical outcome.
Are we causing harm by exposing patients to high-dose statins? All the evidence from randomized trials and observation studies point to the contrary. The basis was very mild nonsignificant muscle weakness observed in some patients. Unless a randomized prospective trial produces results that contradict the results of the many acute nonrandomized studies, statins should be used early after stroke onset, in high doses, and across the spectrum of ischemic stroke subtypes.
Transient Ischemic Attack TIA Symptoms and Treatment
The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. This article is Part 1 of a 3-part article.
Parts 2 and 3 appear on pages andrespectively. A 46 year old woman develops a peri-procedural stroke during cardiac catheterization for atypical chest pain.
Should the patient be started on a statin therapy? We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address. Skip to main content.
Background Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent. high-dose statins; ischemic stroke; statins; stroke outcome; This case raises several questions: (1) Is the role for statins in acute ischemic stroke to improve. Aug 08, · Stroke Patients Benefit From Lipitor. of adding high-dose Lipitor to the regimen of that most stroke patients should be placed on a statin. At my hospital, and perhaps yours too, statin use after stroke has become sacrosanct. Nearly everyone with a diagnosis of stroke gets high-dose atorvastatin. Detailed Atorvastatin dosage information for adults to reduce the risk of myocardial infarction and stroke, lowest effective dose of atorvastatin should be.
Footnotes The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. If yes, should she be started on high-dose 80 mg statin? Should all patients with ischemic stroke be on a statin? Pretreatment with high dose statins, but not low dose statin, ezetimibe or the combination of low dose statin and ezetimibe, limit infarct size in rats. J Cardiovasc Pharmacol Ther. HMG-CoA reductase inhibitors improve acute ischemic stroke outcome. Statins in ischemic stroke: J Stroke Cerebrovasc Dis.
Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: Preexisting statin use is associated with greater reperfusion in hyperacute ischemic stroke.
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High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. Heart Protection Study Collaborative Group. Jump to Article Disclosures Footnotes References.
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