Polymorphisms of the apolipoprotein E gene affect response to atorvastatin therapy in acute ischemic stroke

Comparison of efficacy and safety between loading-dose atorvastatin and rosuvastatin in cerebral infarction

OBJECTIVE

To analyze the efficacy and safety of loading-dose atorvastatin and rosuvastatin in the treatment of cerebral infarction (CI).

METHODS

A total of 151 CI patients treated at the Third Affiliated Hospital of Qiqihar Medical University from January 2015 to February 2020 retrospectively were selected and divided into four groups: conventional atorvastatin, loading-dose atorvastatin, conventional rosuvastatin, and loading-dose rosuvastatin. Primary outcomes assessed included changes in National Institutes of Health Stroke Scale (NIHSS) scores, clinical efficacy, alterations in serum lipid indices, liver function, inflammation markers, CI indices, and the incidence of adverse reactions.

RESULTS

After treatment, all groups showed a significant decrease in NIHSS scores (all P<0.0001). The loading-dose groups exhibited greater reductions in NIHSS scores compared to the conventional groups (both P<0.0001). No significant difference was found in NIHSS scores between the two loading-dose groups (P>0.05). The loading-dose groups demonstrated higher efficacy than the conventional groups (both P<0.05), with no significant difference between the two loading-dose groups (both P>0.05). Loading-dose rosuvastatin showed superior improvement in blood lipid control compared to loading-dose atorvastatin (P<0.05). There were no significant differences in liver function indices among the groups (all P>0.05). Inflammation and myocardial indices intensified 24 hours after treatment, with milder intensification in the loading-dose rosuvastatin group compared to the loading-dose atorvastatin group (P<0.05). The incidences of adverse reactions did not significantly differ among the groups (all P>0.05).

CONCLUSION

Both loading-dose atorvastatin and rosuvastatin demonstrated increased clinical efficacy in the treatment of CI patients, ensuring safety and effectiveness. However, rosuvastatin exhibited superior efficacy in blood lipid control. These findings provide valuable guidance for the clinical management of CI.

What are the benefits and drawbacks of statins in carotid artery disease? A perspective review

INTRODUCTION

The prevalence of carotid artery stenosis in the general population is approximately 3%, but approximately 20% among people with acute ischemic stroke. Statins are recommended by multiple international guidelines as the drug of choice for lipid control in people with asymptomatic or symptomatic carotid artery stenosis due to their lipid-lowering and other pleiotropic effects.

AREAS COVERED

This review discusses the guidelines for statin usage as a cornerstone in the prevention and management of atherosclerotic carotid artery disease and the impact of statins on stroke incidence and mortality. Statin side effects, alternative therapy, and genetic polymorphisms are reviewed.

EXPERT OPINION

Statin therapy is associated with a decreased incidence of stroke and mortality as well as improved outcomes for patients treated with carotid revascularization. Statins are a safe and effective class of medications, but the initiation of therapy warrants close monitoring to avoid rare and potentially serious side effects. Lack of clinical efficacy or the presence of side effects suggests a need for treatment with an alternative therapy such as PCSK9 inhibitors. Understanding the interplay between the mechanisms of statins and PCSK9 inhibition therapies will allow optimal benefits while minimizing risks. Future research into genetic polymorphisms may improve patient selection for personalized therapy.

Biological and Clinical Implications of Sex-Specific Differences in Alzheimer's Disease

Mounting evidence indicates that the female sex is a risk factor for Alzheimer's disease (AD), the most common cause of dementia worldwide. Decades of research suggest that sex-specific differences in genetics, environmental factors, hormones, comorbidities, and brain structure and function may contribute to AD development. However, although significant progress has been made in uncovering specific genetic factors and biological pathways, the precise mechanisms underlying sex-biased differences are not fully characterized. Here, we review several lines of evidence, including epidemiological, clinical, and molecular studies addressing sex differences in AD. In addition, we discuss the challenges and future directions in advancing personalized treatments for AD.