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Thomas RG, Kim JH, Kim JH, Yoon J, Choi KH, Jeong YY. Treatment of Ischemic Stroke by Atorvastatin-Loaded PEGylated Liposome. Transl Stroke Res 2024; 15:388-398. [PMID: 36639607 DOI: 10.1007/s12975-023-01125-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 12/16/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023]
Abstract
There is insufficient evidence on the effect of nanoparticles, particularly liposomes loaded with a statin, on acute ischemic stroke. We investigated the impact of atorvastatin-loaded PEG (polyethylene glycol) conjugated liposomes (LipoStatin) on the outcomes in rats with cerebral ischemia-reperfusion. PEGylated liposome loaded with atorvastatin was developed as a nanoparticle to specifically accumulate in an ischemic region and release the drug to ameliorate the harmful effects of the stroke. LipoStatin was administered to rats with transient middle cerebral artery occlusion through the tail vein immediately after reperfusion (LipoStatin group). LipoStatin efficiently accumulated at the cerebral ischemic injury site of the rat. The LipoStatin group showed a significantly reduced infarct volume (p < 0.01) in brain micro-MR imaging and improved neurological function recovery compared to the control group (p < 0.05). In addition, markedly improved brain metabolism using fluorine-18 fluorodeoxyglucose micro-PET/CT imaging was demonstrated in the LipoStatin group compared with the control group (p < 0.01). Mechanistically, as a result of evaluation through IL-1 beta, TNF-alpha, ICAM-1, and Iba-1 mRNA expression levels at 5 days after cerebral ischemia, LipoStatin showed significant anti-inflammatory effects. Protein expression of occludin, JAM-A, Caveolin-1, and eNOS by western blot at 3 days and fluorescent images at 7 days showed considerable recovery of blood-brain barrier breakdown and endothelial dysfunction. PEGylated LipoStatin can be more effectively delivered to the ischemic brain and may have significant neuroprotective effects. Thus, PEGylated LipoStatin can be further developed as a promising targeted therapy for ischemic stroke and other major vascular diseases.
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Affiliation(s)
- Reju George Thomas
- Department of Radiology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea
| | - Ja-Hae Kim
- Department of Nuclear Medicine, Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Ji-Hye Kim
- Department of Neurology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea
| | - Jungwon Yoon
- School of Integrated Technology, Gwangju Institute of Science and Technology, Gwangju, South Korea
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea.
| | - Yong-Yeon Jeong
- Department of Radiology, Chonnam National University Medical School and Hwasun Hospital, 322 Seoyang-Ro, Hwasun-Eup, Hwasun-Gun, Jeollanam-Do, 58128, South Korea.
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Yu IC, Kuo PC, Yen JH, Paraiso HC, Curfman ET, Hong-Goka BC, Sweazey RD, Chang FL. A Combination of Three Repurposed Drugs Administered at Reperfusion as a Promising Therapy for Postischemic Brain Injury. Transl Stroke Res 2017. [PMID: 28624878 DOI: 10.1007/s12975-017-0543-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cerebral ischemia leads to multifaceted injury to the brain. A polytherapeutic drug that can be administered immediately after reperfusion may increase protection to the brain by simultaneously targeting multiple deleterious cascades. This study evaluated efficacy of the combination of three clinically approved drugs: lamotrigine, minocycline, and lovastatin, using two mouse models: global and focal cerebral ischemia induced by transient occlusion of the common carotid arteries or the middle cerebral artery, respectively. In vitro, the combination drug, but not single drug, protected neurons against oxygen-glucose deprivation (OGD)-induced cell death. The combination drug simultaneously targeted cell apoptosis and DNA damage induced by ischemia. Besides acting on neurons, the combination drug suppressed inflammatory processes in microglia and brain endothelial cells induced by ischemia. In a transient global ischemia model, the combination drug, but not single drug, suppressed microglial activation and inflammatory cytokine production, and reduced neuronal damage. In a transient focal ischemia model, the combination drug, but not single drug, attenuated brain infarction, suppressed infiltration of peripheral neutrophils, and reduced neurological deficits following ischemic stroke. In summary, the combination drug confers a broad-spectrum protection against ischemia/reperfusion (I/R) injury and could be a promising approach for early neuroprotection after out-of-hospital cardiac arrest or ischemic stroke.
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Affiliation(s)
- I-Chen Yu
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA.
| | - Ping-Chang Kuo
- Department of Microbiology and Immunology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Jui-Hung Yen
- Department of Microbiology and Immunology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Hallel C Paraiso
- Department of Biology, Indiana University-Purdue University Fort Wayne, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Eric T Curfman
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Benecia C Hong-Goka
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Robert D Sweazey
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA
| | - Fen-Lei Chang
- Department of Neurology, Indiana University School of Medicine, 2101 E. Coliseum Boulevard, Fort Wayne, IN, 46805, USA.
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O'Brien EC, Greiner MA, Xian Y, Fonarow GC, Olson DM, Schwamm LH, Bhatt DL, Smith EE, Maisch L, Hannah D, Lindholm B, Peterson ED, Pencina MJ, Hernandez AF. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation 2015; 132:1404-13. [PMID: 26246175 DOI: 10.1161/circulationaha.115.016183] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 07/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with ischemic stroke, data on the real-world effectiveness of statin therapy for clinical and patient-centered outcomes are needed to better inform shared decision making. METHODS AND RESULTS Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) is a Patient-Centered Outcomes Research Institute-funded research program designed with stroke survivors to evaluate the effectiveness of poststroke therapies. We linked data on patients ≥65 years of age enrolled in the Get With The Guidelines-Stroke Registry to Medicare claims. Two-year to postdischarge outcomes of those discharged on a statin versus not on a statin were adjusted through inverse probability weighting. Our coprimary outcomes were major adverse cardiovascular events and home time (days alive and out of a hospital or skilled nursing facility). Secondary outcomes included all-cause mortality, all-cause readmission, cardiovascular readmission, and hemorrhagic stroke. From 2007 to 2011, 77 468 patients who were not taking statins at the time of admission were hospitalized with ischemic stroke; of these, 71% were discharged on statin therapy. After adjustment, statin therapy at discharge was associated with a lower hazard of major adverse cardiovascular events (hazard ratio, 0.91; 95% confidence interval, 0.87-0.94), 28 more home-time days after discharge (P<0.001), and lower all-cause mortality and readmission. Statin therapy at discharge was not associated with increased risk of hemorrhagic stroke (hazard ratio, 0.94; 95% confidence interval, 0.72-1.23). Among statin-treated patients, 31% received a high-intensity dose; after risk adjustment, these patients had outcomes similar to those of recipients of moderate-intensity statin. CONCLUSION In older ischemic stroke patients who were not taking statins at the time of admission, discharge statin therapy was associated with lower risk of major adverse cardiovascular events and nearly 1 month more home time during the 2-year period after hospitalization.
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Affiliation(s)
- Emily C O'Brien
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution.
| | - Melissa A Greiner
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Ying Xian
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Gregg C Fonarow
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - DaiWai M Olson
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Lee H Schwamm
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Deepak L Bhatt
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Eric E Smith
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Lesley Maisch
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Deidre Hannah
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Brianna Lindholm
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Eric D Peterson
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Michael J Pencina
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
| | - Adrian F Hernandez
- From Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (E.C.O., M.A.G., Y.X., E.D.P., M.J.P., A.F.H.); University of California at Los Angeles, Los Angeles (G.C.F.); University of Texas Southwestern, Dallas (D.M.O.); Harvard-Massachusetts General Hospital, Cambridge (L.H.S.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (E.E.S.); and Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada (E.E.S.). L. Maisch, D. Hannah, and B. Lindholm are PROSPER patient investigators and are not affiliated with a particular research institution
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Ho LT, Yin WH, Chuang SY, Tseng WK, Wu YW, Hsieh IC, Lin TH, Li YH, Huang LC, Wang KY, Ueng KC, Fang CC, Pan WH, Yeh HI, Wu CC, Chen JW. Determinants for achieving the LDL-C target of lipid control for secondary prevention of cardiovascular events in Taiwan. PLoS One 2015; 10:e0116513. [PMID: 25756522 PMCID: PMC4355583 DOI: 10.1371/journal.pone.0116513] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 11/28/2014] [Indexed: 11/05/2022] Open
Abstract
Background Epidemiological and clinical studies have clearly established the link between low-density lipoprotein cholesterol (LDL-C) and atherosclerosis-related cardiovascular consequences. Although it has been a common practice for physicians to prescribe lipid-lowering therapy for patients with dyslipidemia, the achievement rate is still not satisfied in Taiwan. Therefore, the determinants for achieving the LDL-C target needed to be clarified for better healthcare of the patients with dyslipidemia. Method This registry-type prospective observational study enrolled the patients with cardiovascular diseases (coronary artery disease (CAD) and cerebrovascular disease (CVD)) from 18 medical centers across Taiwan, and clinically followed them for five years. At every clinical visit, vital signs, clinical endpoints, adverse events, concurrent medications and laboratory specimens were obtained as thoroughly as possible. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, LDL-C, triglyceride), liver enzymes, and creatinine phosphokinase were evaluated at baseline, and every year thereafter. The cross sectional observational data was analyzed for this report. Result Among the 3,486 registered patients, 54% had their LDL-C < 100 mg/dL. By univariate analysis, the patients achieving the LDL-C target were associated with older age, more male sex, taller height, lower blood pressure, more under lipid-lowering therapy, more smoking cessation, more history of CAD, DM, physical activity, but less history of CVD. The multivariate analysis showed statin therapy was the most significant independent determinant for achieving the treatment target, followed by age, history of CAD, diabetes, blood pressure, and sex. However, most patients were on regimens of very-low to low equipotent doses of statins. Conclusion Although the lipid treatment guideline adherence is improving in recent years, only 54% of the patients with cardiovascular diseases have achieved their LDL-C target in Taiwan, and the most significant determinant for this was statin therapy.
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Affiliation(s)
- Li-Ting Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wei-Hsian Yin
- Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, and School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Wei-Kung Tseng
- Department of Medical Imaging and Radiological Sciences, I-Shou University and Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center and Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - I-Chang Hsieh
- Second Department of Cardiology, Chang-Gung Memorial Hospital, New Taipei City, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Heng Li
- Department of Internal Medicine, National Cheng Kung University Hospital and College of Medicine, Tainan, Taiwan
| | - Lien-Chi Huang
- Department of Cardiology, Taipei Union Hospital, Taipei, Taiwan
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital and Department of Medicine, Chung-Shan Medical University, Taichung, Taiwan
| | - Kwo-Chang Ueng
- School of Medicine, Chung Shan Medical University and Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Chang Fang
- Division of Cardiology, Department of Internal Medicine, Tainan Municipal Hospital, Tainan, Taiwan
| | - Wen-Harn Pan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
| | - Chau-Chung Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
- Department of Primary Care Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
| | - Jaw-Wen Chen
- Department of Medical Research and Education, Taipei Veterans General Hospital and Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
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Canavero I, Cavallini A, Perrone P, Magoni M, Sacchi L, Quaglini S, Lanzola G, Micieli G. Clinical factors associated with statins prescription in acute ischemic stroke patients: findings from the Lombardia Stroke Registry. BMC Neurol 2014; 14:53. [PMID: 24650199 PMCID: PMC3994484 DOI: 10.1186/1471-2377-14-53] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 03/17/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Statins, due to their well-established pleiotropic effects, have noteworthy benefits in stroke prevention. Despite this, a significant proportion of high-risk patients still do not receive the recommended therapeutic regimens, and many others discontinue treatment after being started on them. The causes of non-adherence to current guidelines are multifactorial, and depend on both physicians and patients. The aim of this study is to identify the factors influencing statin prescription at Stroke Unit (SU) discharge. METHODS This study included 12,750 patients enrolled on the web-based Lombardia Stroke Registry (LRS) from July 2009 to April 2012 and discharged alive, with a diagnosis of ischemic stroke or transient ischemic attack (TIA) and without contra-indication to statin therapy. By logistic regression analysis and classification trees, we evaluated the impact of demographic data, risk factors, tPA treatment, in-hospital procedures and complications on statin prescription rate at discharge. RESULTS We observed a slight increase in statins prescription during the study period (from 39.1 to 43.9%). Lower age, lower stroke severity and prestroke disability, the presence of atherothrombotic/lacunar risk factors, a diagnosis of non-cardioembolic stroke, tPA treatment, the absence of in-hospital complications, with the sole exception of hypertensive fits and hyperglycemia, were the patient-related predictors of adherence to guidelines by physicians. Overall, dyslipidemia appears as the leading factor, while TOAST classification does not reach statistical significance. CONCLUSIONS In our region, Lombardia, adherence to guidelines in statin prescription at Stroke Unit discharge is very different from international goals. The presence of dyslipidemia remains the main factor influencing statin prescription, while the presence of well-defined atherosclerotic etiopathogenesis of stroke does not enhance statin prescription. Some uncertainties about the risk/benefit of statin therapy in stroke etiology subtypes (cardioembolism, other or undetermined causes) may partially justify the underuse of statin in ischemic stroke. The differences that exist between current international guidelines may prevent a more widespread use of statin and should be clarified in a consensus.
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Affiliation(s)
- Isabella Canavero
- Department of Emergency Neurology/Stroke Unit, National Neurologic Institute C. Mondino IRCCS, Pavia, Italy
| | - Anna Cavallini
- Department of Emergency Neurology/Stroke Unit, National Neurologic Institute C. Mondino IRCCS, Pavia, Italy
| | | | - Mauro Magoni
- Neurovascular Unit, ‘Spedali Civili’ Hospital, Brescia, Italy
| | - Lucia Sacchi
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Silvana Quaglini
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giordano Lanzola
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
| | - Giuseppe Micieli
- Department of Emergency Neurology/Stroke Unit, National Neurologic Institute C. Mondino IRCCS, Pavia, Italy
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