Abstract TMP46: Is There an Effect of Statins on Ischemic Stroke Functional Outcomes in the Oldest Old?

Background: The net health benefit of statin use in the oldest patients remains controversial. Preclinical models and previous clinical studies have suggested statins may exhibit neuroprotective effects in stroke, however evidence in the very old remains limited. Our objective was to compare changes in functional status before and after acute ischemic stroke (AIS) between statin users and non-users in a national cohort. Methods: A patient’s first hospitalization for AIS from 04/01/11 to 12/31/2012 was selected from Medicare Part A claims. Patients with a pre-hospitalization nursing home Minimum Data Set assessment and a post-hospitalization assessment in a skilled nursing facility were included. Pre-stroke statin exposure was defined using Part D claims. Functional status was measured continuously and categorically (dependent:<20, partially dependent(PD):20-59, assisted independent(AI):60-100) using Shah’s modified Barthel Index (mBI). Multivariable logistic regression examined the association of statins with a minimum clinically important mBI decrease of 10 points among non-dependent patients. Results: Among 10,203 patients with an assessment before hospitalization, 7.2% died, and 48.7% were included (mean age: 83.6±9.6; 74.5% women). Statin use was common (36.5%), while acute treatment was infrequent (thrombolysis: 4.9%; thrombectomy: 0.1%). The distribution of functional dependence, PD, and AI shifted from 17.3%, 56.1%, and 26.7% at baseline to 49.7%, 44.4%, and 5.9% post-stroke, respectively. A consistent association with 10-point mBI decline was observed for statin exposure among all non-dependent (OR: 0.8; 95%CI: 0.7-1.0) and within strata of PD (OR:0.8; 95%CI: 0.7-1.0) and AI patients (OR: 0.8; 95%CI: 0.5-1.3). In contrast, acute treatment was more strongly associated with function in AI (OR: 0.5; 95%CI: 0.2-1.0) versus PD patients (OR: 1.0; 95%CI: 0.7-1.5). Conclusion: In this high-burden population, our results are suggestive of a possible protective association for pre-stroke statin exposure. Further research is needed to examine temporal and dose-response relationships between statin exposure and functional outcomes across diverse patient populations.

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Prestroke statin use enhances collateralization in acute ischemic stroke patients

Restorative Neurology and Neuroscience ◽

10.3233/rnn-201012 ◽

2020 ◽

Vol 38 (4) ◽

pp. 311-321

Author(s):

Jiaying Zhu ◽

Mengmeng Ma ◽

Jinghuan Fang ◽

Jiajia Bao ◽

Shuju Dong ◽

...

Keyword(s):

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Acute Ischemic Stroke ◽

Statin Therapy ◽

Cerebral Artery ◽

Functional Outcomes ◽

Collateral Circulation ◽

Stroke Severity ◽

Stroke Patients ◽

Statin Use

Background: Statin therapy has been shown to be effective in the prevention of ischemic stroke. In addition, recent studies have suggested that prior statin therapy could lower the initial stroke severity and improve stroke functional outcomes in the event of stroke. It was speculated that prestroke statin use may enhance collateral circulation and result in favorable functional outcomes. Objective: The aim of the study was to investigate the association of prestroke statin use with leptomeningeal collaterals and to determine the association of prestroke statin use with stroke severity and functional outcome in acute ischemic stroke patients. Methods: We prospectively and consecutively enrolled 239 acute ischemic stroke patients with acute infarction due to occlusion of the middle cerebral artery within 24 h in the neurology department of West China Hospital from May 2011 to April 2017. Computed tomographic angiography (CTA) imaging was performed for all patients to detect middle cerebral artery thrombus; regional leptomeningeal collateral score (rLMCS) was used to assess the degree of collateral circulation; the National Institutes of Health Stroke Scale (NIHSS) was used to measure stroke severity at admission; the modified Rankin scale (mRS) was used to measure outcome at 90 days; and premorbid medications were recorded. Univariate and multivariate analyses were performed. Results: Overall, 239 patients met the inclusion criteria. Fifty-four patients used statins, and 185 did not use statins before stroke onset. Prestroke statin use was independently associated with good collateral circulation (rLMCS > 10) (odds ratio [OR], 4.786; 95% confidence interval [CI], 1.195–19.171; P = 0.027). Prestroke statin use was not independently associated with lower stroke severity (NIHSS score≤14) (OR, 1.955; 95% CI, 0.657–5.816; p = 0.228), but prestroke statin use was independently associated with favorable outcome (mRS score≤2) (OR, 3.868; 95% CI, 1.325–11.289; P = 0.013). Conclusions: Our findings suggest that prestroke statin use was associated with good leptomeningeal collaterals and clinical outcomes in acute ischemic stroke (AIS) patients presenting with occlusion of the middle cerebral artery. However, clinical studies should be conducted to verify this claim.

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093: Effect of Pre-Existing Statin Use on in-Hospital Mortality and Functional Status at Discharge in Ischemic Stroke Patients

American Journal of Epidemiology ◽

10.1093/aje/161.supplement_1.s23c ◽

2005 ◽

Vol 161 (Supplement_1) ◽

pp. S23-S23

Author(s):

M J Reeves ◽

A Mullard ◽

J Gargano ◽

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Functional Status ◽

Stroke Patients ◽

Statin Use

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Pre-Stroke Glycemic Variability Estimated by Glycated Albumin Is Associated with Early Neurological Deterioration and Poor Functional Outcome in Prediabetic Patients with Acute Ischemic Stroke

Cerebrovascular Diseases ◽

10.1159/000511938 ◽

2020 ◽

pp. 1-8

Author(s):

Sang-Hwa Lee ◽

Yerim Kim ◽

So Young Park ◽

Chulho Kim ◽

Yeo Jin Kim ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Status ◽

Functional Outcome ◽

Functional Outcomes ◽

Glycated Albumin ◽

Glycemic Variability ◽

Poor Functional Outcome ◽

Early Neurological Deterioration ◽

Poor Functional Status

Introduction: Whether glycemic variability prior to stroke increases the risk of stroke outcomes in prediabetic patients presenting with acute ischemic stroke is still unclear. We evaluated whether pre-stroke glycemic variability, estimated by glycated albumin (GA), increased early neurological deterioration (END) and functional outcomes in prediabetic patients with acute ischemic stroke. Methods: A total of 215 acute ischemic stroke patients with prediabetes were evaluated. The primary outcome was END, defined as an incremental increase in the National Institutes of Health Stroke Scale score by ≥1 point in motor power or ≥2 points in the total score within the 7 days after admission. The secondary outcome was poor functional status defined by a modified Rankin Scale at 3 months. Higher GA (≥16.0%) was determined to reflect glycemic fluctuation prior to ischemic stroke. Results: Of the 215 prediabetic patients, 77 (35.8%) were in the higher GA group. In prediabetic patients, END occurrence and poor functional status were higher in the higher GA group than in the lower GA group. The multivariate analysis showed that a higher GA was associated with an increased risk of END occurrence and poor functional outcomes at 3 months (adjusted odds ratio [95% confidence interval], 4.58 [1.64–12.81], p = 0.004 and 2.50 [1.19–5.25], p = 0.02, respectively). Conclusion: Pre-stroke glycemic variability estimated by GA was associated with END occurrence and poor functional outcome after ischemic stroke in patients with prediabetes.

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Associations between frequency of tea consumption and health and mortality: evidence from old Chinese

British Journal Of Nutrition ◽

10.1017/s0007114511007173 ◽

2012 ◽

Vol 108 (9) ◽

pp. 1686-1697 ◽

Cited By ~ 15

Author(s):

Li Qiu ◽

Jessica Sautter ◽

Danan Gu

Keyword(s):

Oldest Old ◽

Health Benefit ◽

Tea Consumption ◽

Data Set ◽

Very Old ◽

Old Adults ◽

Risk Of Death ◽

Healthy Longevity ◽

Old Men ◽

Health And Mortality

Tea consumption may be associated with reduced risk of morbidity and mortality; however, this association is not conclusive and has rarely been investigated among very old adults. The present study examines how self-reported frequency of tea consumption in daily life is associated with health and mortality among very old adults in China. The data are from a national longitudinal data set that included 32 606 individuals (13 429 men and 19 177 women) aged 65 years and older: 11 807 respondents aged 65 to 84 years and 20 799 respondents aged 85 years and older. A total of four measurements between 1998 and 2005 resulted in 51 668 observations. Hazard regressions showed that men who drink tea almost every day have a 10–20 % lower risk of death compared to their counterparts who seldom drink tea, after adjusting for numerous confounders including baseline health. This relationship was stronger in younger male elders aged 65 to 84 years than in the oldest-old men aged 85 years and older. However, frequency of tea consumption was not significantly associated with mortality in women. Our analyses further show that high frequency of tea consumption is significantly associated with reduced OR of disability in activities of daily living, cognitive impairment, self-rated poor health, cumulative health deficits and CVD in both young elders and the oldest-old, and in both men and women. These results suggest that the health benefit of drinking tea is universal. We conclude that frequent tea consumption probably helps one achieve healthy longevity and that men benefit more from such lifestyles.

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The iScore Predicts Poor Functional Outcomes Early After Hospitalization for an Acute Ischemic Stroke

Stroke ◽

10.1161/strokeaha.111.623116 ◽

2011 ◽

Vol 42 (12) ◽

pp. 3421-3428 ◽

Cited By ~ 50

Author(s):

Gustavo Saposnik ◽

Stavroula Raptis ◽

Moira K. Kapral ◽

Ying Liu ◽

Jack V. Tu ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Prediction Tool ◽

Poor Functional Outcome ◽

Data Set ◽

Risk Of Death ◽

External Data ◽

Poor Outcomes ◽

Stroke Center

Background and Purpose— The iScore is a prediction tool originally developed to estimate the risk of death after hospitalization for an acute ischemic stroke. Our objective was to determine whether the iScore could also predict poor functional outcomes. Methods— We applied the iScore to patients presenting with an acute ischemic stroke at multiple hospitals in Ontario, Canada, between 2003 and 2008, who had been identified from the Registry of the Canadian Stroke Network regional stroke center database (n=3818) and from an external data set, the Registry of the Canadian Stroke Network Ontario Stroke Audit (n=4635). Patients were excluded if they were included in the sample used to develop and validate the initial iScore. Poor functional outcomes were defined as: (1) death at 30 days or disability at discharge, in which disability was defined as having a modified Rankin Scale 3 to 5; and (2) death at 30 days or institutionalization at discharge. Results— The prevalence of poor functional outcomes in the Registry of the Canadian Stroke Network and the Ontario Stroke Audit, respectively, were 55.7% and 44.1% for death at 30 days or disability at discharge and 16.9% and 16.2%, respectively, for death at 30 days or institutionalization at discharge. The iScore stratified the risk of poor outcomes in low- and high-risk individuals. Observed versus predicted outcomes showed high correlations: 0.988 and 0.940 for mortality or disability and 0.985 and 0.993 for mortality or institutionalization in the Registry of the Canadian Stroke Network and Ontario Stroke Audit cohorts. Conclusions— The iScore can be used to estimate the risk of death or a poor functional outcome after an acute ischemic stroke.

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Heat Shock Protein 70 kDa as a Target for Diagnostics and Therapy of Cardiovascular and Cerebrovascular Diseases

Current Pharmaceutical Design ◽

10.2174/1381612825666190329123924 ◽

2019 ◽

Vol 25 (6) ◽

pp. 710-714 ◽

Cited By ~ 2

Author(s):

Ekaterina V. Konstantinova ◽

Natalia S. Chipigina ◽

Marina H. Shurdumova ◽

E.I. Kovalenko ◽

Alexander M. Sapozhnikov

Keyword(s):

Myocardial Infarction ◽

Ischemic Stroke ◽

Heat Shock ◽

Cerebrovascular Diseases ◽

Peripheral Blood Lymphocytes ◽

Neuroprotective Effects ◽

Adverse Conditions ◽

Shock Proteins ◽

Diagnostics And Therapy ◽

Main Factor

Acute focal ischemia is a main factor of pathogenesis of a number of widespread cardiovascular and cerebrovascular diseases, in particular, myocardial infarction and ischemic stroke. It is known that under the conditions of ischemia expression of intracellular heat shock proteins (HSPs), especially HSP70, grows greatly irrespective of the cell type. This stress-induced cell response is connected with cytoprotective properties of HSP70. The protective functions of HSP70 contribute to the cell survival under adverse conditions and inhibit development of programmed cell death. It was shown, that the level of HSP70 increases in cardiomyocytes and brain cells in response to ischemia, that was connected with cardioprotective and neuroprotective effects. Besides, in recent years, clinical studies of HSP70 have demonstrated elevated level of HSP70 in peripheral blood lymphocytes in groups of patients with ischemic stroke and myocardial infarction. This review indicates that HSP70 can serve as a target for developing new approaches to diagnostics and therapy of cardiovascular and cerebrovascular diseases.

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Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

Current Neurovascular Research ◽

10.2174/1567202617666200521083132 ◽

2020 ◽

Vol 17 (4) ◽

pp. 361-375

Author(s):

Victor C. Schulz ◽

Pedro S.C. de Magalhaes ◽

Camila C. Carneiro ◽

Julia I.T. da Silva ◽

Vivian N. Silva ◽

...

Keyword(s):

Ischemic Stroke ◽

Real World ◽

Time Window ◽

Functional Dependence ◽

Developed Countries ◽

First Year ◽

Middle Income ◽

Probability Of Survival ◽

Stroke Center ◽

Cerebral Reperfusion

Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil. Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group). Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year. Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.

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Role of Acute Lesion Topography in Initial Ischemic Stroke Severity and Long-Term Functional Outcomes

Stroke ◽

10.1161/strokeaha.115.009643 ◽

2015 ◽

Vol 46 (9) ◽

pp. 2438-2444 ◽

Cited By ~ 60

Author(s):

Ona Wu ◽

Lisa Cloonan ◽

Steven J.T. Mocking ◽

Mark J.R.J. Bouts ◽

William A. Copen ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcomes ◽

Stroke Severity ◽

Acute Lesion ◽

Lesion Topography

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The Effects ofChunghyul-Dan(A Korean Medicine Herbal Complex) on Cardiovascular and Cerebrovascular Diseases: A Narrative Review

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2016/2601740 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

Woo-Sang Jung ◽

Seungwon Kwon ◽

Seung-Yeon Cho ◽

Seong-Uk Park ◽

Sang-Kwan Moon ◽

...

Keyword(s):

Ischemic Stroke ◽

Ethanol Extract ◽

Inhibitory Effect ◽

Cerebrovascular Diseases ◽

Stroke Recurrence ◽

Neuroprotective Effects ◽

Clinical Safety ◽

Endogenous Catecholamine ◽

Rhei Rhizoma ◽

Coa Reductase

Chunghyul-dan(CHD) is a herbal complex containing 80% ethanol extract and is composed ofScutellariae Radix,Coptidis Rhizoma,Phellodendri Cortex,Gardeniae Fructus, andRhei Rhizoma. We have published several experimental and clinical research articles on CHD. It has shown antilipidemic, antihypertensive, antiatherosclerotic, and inhibitory effects on ischemic stroke recurrence with clinical safety in the previous studies. The antilipidemic effect of CHD results from 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase and pancreatic lipase-inhibitory activity. The antihypertensive effect likely results from the inhibitory effect on endogenous catecholamine(s) release and harmonization of all components showing the antihypertensive effects. Furthermore, anti-inflammatory and antioxidant effects on endothelial cells are implicated to dictate the antiatherosclerotic effects of CHD. It also showed neuroprotective effects on cerebrovascular and parkinsonian models. These effects of CHD could be helpful for the prevention of the recurrence of ischemic stroke. Therefore, we suggest that CHD could be a promising medication for treating and preventing cerebrovascular and cardiovascular diseases. However, to validate and better understand these findings, well-designed clinical studies are required.

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