Editorial Comment—Statins, Stroke Outcome, and Stroke Prevention: When Should We Start Treatment?

Factors associated with functional outcomes of patients with cerebral embolism due to nonvalvular atrial fibrillation

OBJECTIVE

This study aimed to identify factors associated with the functional outcomes of patients with cerebral embolism due to nonvalvular atrial fibrillation.

METHODS

We retrospectively investigated the short-term functional outcomes of 134 patients diagnosed with cardiogenic cerebral embolism due to nonvalvular atrial fibrillation during the period of May 2006 to August 2008. Functional state was evaluated using the modified Rankin Scale (mRS) on admission and at discharge.

RESULTS

A good functional outcome (mRS ≤2) at discharge was significantly associated with low mRS on admission (OR: 0.07; CI: 0.03-0.18; p<0.001), and a low C-reactive protein (CRP) level (OR: 0.19; CI: 0.04-0.89; p<0.05). Functional improvement during admission was positively associated with the presence of dyslipidemia (OR: 2.74; CI: 1.11-6.76; p<0.05), whereas high diastolic blood pressure (OR: 0.95; CI: 0.90-0.99; p<0.05) and a high blood sugar level (OR: 0.98; CI: 0.97-0.99; p<0.05) on admission were inversely associated with functional improvement. Furthermore, no relationship existed between mRS on admission and functional improvement during hospitalization.

CONCLUSION

The results suggest that a good functional state at discharge was associated with a good functional state on admission as well as a low serum CRP level. On the other hand, functional improvement was associated with the presence of dyslipidemia, low diastolic blood pressure, and low blood sugar level on admission.

Stroke prognosis in diabetes mellitus: new insights but questions remain

Diabetes is not only an independent risk factor for lacunar infarction, especially in patients with multiple lacunar infarcts, but the presence of diabetes is also associated with worse functional recovery in these patients.

The role of statins in the prevention of ischemic stroke

Statin treatment has been demonstrated to diminish the risk for stroke in patients with coronary heart disease, hypercholesterolemia, normocholesterolemia, in the elderly, and among hypertensive and diabetic patients. Stroke incidence in patients on statin treatment has been reduced in all these clinical settings involving both primary and secondary prevention but not in patients with previous stroke. Two recent meta-analyses confirm this conclusion. The mechanism by which statins provide benefit against stroke is likely multifactorial, involving both the low-density lipoprotein cholesterol-lowering effect with stabilization of vulnerable plaques, and pleiotropic effects such as improvement of endothelial function, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory responses, immunomodulatory actions, and regulation of progenitor cells.