scholarly journals Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lanying He ◽  
Ronghua Xu ◽  
Jian Wang ◽  
Lili Zhang ◽  
Lijuan Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Density ◽  
Composite Outcome ◽  
Oxidized Low Density Lipoprotein

Abstract Background Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72 h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score ≥ 3), and composite outcome (death/major disability) at 3 months after AIS. Results One hundred thirty-six patients were in no prestroke statins use group, and 106 in prestroke statins use group. Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P < 0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval (CI), 0.99–1.12; P = 0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P = 0.031)], major disability (adjusted OR, 0.38; 95% CI, 0.15–0.99; P = 0.047), and composite outcome (adjusted OR, 0.31; 95% CI, 0.17–0.74; P = 0.009). Conclusions Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

scholarly journals Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

2019 ◽  
Author(s):  
lanying he ◽  
Ronghua Xu ◽  
Jian Wang ◽  
LIli Zhang ◽  
Lijuan Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Density ◽  
Composite Outcome ◽  
Oxidized Low Density Lipoprotein

Abstract Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS. Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009). Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

scholarly journals Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

2019 ◽  
Author(s):  
lanying he ◽  
Ronghua Xu ◽  
Jian Wang ◽  
LIli Zhang ◽  
Lijuan Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Enzyme Linked Immunosorbent Assay ◽  
Low Density ◽  
Composite Outcome ◽  
Oxidized Low Density Lipoprotein

Abstract Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS). Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and n o prestroke statins use groups , who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score≥3), and composite outcome (death/major disability) at 3 months after AIS. Results: 136 patients were in no prestroke statins use group, and 106 in prestroke statins use group . Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P<0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval(CI), 0.99-1.12; P=0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16–0.91; P=0.031)], major disability (adjusted OR, 0.38; 95%CI, 0.15–0.99; P=0.047), and composite outcome (adjusted OR, 0.31; 95% CI,0.17–0.74; P=0.009). Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

scholarly journals Prestroke statins use reduces oxidized low density lipoprotein level and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

2019 ◽  
Author(s):  
lanying he ◽  
Ronghua Xu ◽  
Jian Wang ◽  
LIli Zhang ◽  
Lijuan Zhang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein

Abstract Background Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL level and improve clinical outcomes in patients with AF related acute ischemic stroke(AIS). Methods This was a multicenter consecutive trial that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Ox-LDL was measured using enzyme-linked immunosorbent assay (ELISA) on admission and 3 months. The outcome was death or major disability (modified Rankin Scale score≥3) at 3 months after AIS. Results Plasma Ox-LDL level was significantly lower in prestroke statins use than in no prestroke statins use on admission (P=0.001). Plasma Ox-LDL level on admission were associated with 3-month outcome(P<0.05).In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality (adjusted odds ratio, 0.43; 95% confidence interval, 0.20–0.93; P=0.031), major disability (adjusted odds ratio, 0.33; 95% confidence interval, 0.13–0.82; P=0.017), and composite outcome (adjusted odds ratio, 0.25; 95% confidence interval,0.11–0.56; P=0.001). Conclusions Prestroke statins use can reduce plasma Ox-LDL level and improve clinical outcomes in patients with AF related AIS.

Abstract WP372: Quality Improvement in Acute Ischemic Stroke Care in Taiwan: the Breakthrough Collaborative in Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Jiann-Shing Jeng ◽  
Li-Ming Lien ◽  
Tsong-Hai Lee ◽  
Chang-Ming Chern ◽  
Hung-Yi Chiou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Quality Improvement ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Guideline Adherence ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Intravenous Thrombolysis ◽  
Lipid Lowering ◽  
Low Density

Background and Purpose: Guideline adherence for acute ischemic stroke (AIS) management is often suboptimal, particularly in thrombolytic therapy and anticoagulants for atrial fibrillation. We sought to achieve quality improvement of AIS patients via a collaborative learning model, the Breakthrough Series (BTS)-Stroke, in a nationwide, multi-center activity in Taiwan. Methods: A BTS Collaborative, a short-term learning system for a large number of multidisciplinary teams from hospitals, was applied to enhance AIS care quality. There were 24 teaching and community hospitals participating in and submitting data for this stroke quality improvement campaign from August 2010 to June 2011. The Get With The Guideline (GWTG)-Stroke measures were adopted to evaluate the performance and outcome of the AIS patients. The results of this study were compared to those of the previous Taiwan Stroke Registry (TSR, 22642 AIS patients from 39 hospitals, 2006-08). Results: Data from 24 hospitals with 13181 AIS patients during a 1-year period were analyzed. The BTS-Stroke (2010-11) had better performance as compared to the TSR (2006-08): intravenous thrombolysis frequency for all AIS patients (4.1% vs 1.5%), symptomatic hemorrhage after intravenous thrombolysis (6.0% vs 8.2%), early antithrombotics (96.6% vs 94.1%), anticoagulation for atrial fibrillation (57.1% vs 28.3%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (63.4% vs 38.7%), antithrombotics at discharge (94.0% vs 85.5%), and one-month mortality (3.5% vs 4.0%). Temporal improvement was noted in 7 of 14 performance measures when the fourth BTS-Stroke quarter compared with the first quarter: intravenous thrombolysis frequency for all AIS patients (4.1% vs 3.7%), symptomatic hemorrhage after intravenous thrombolysis (3.4% vs 5.5%), lipid lowering drugs for low-density lipoprotein >100 mg/dL (67.3% vs 60.5%), antithrombotics at discharge (95.5% vs 91.4%), dysphagia screening (81.9% vs 63.4%), early rehabilitation (71.7% vs 63.6%), stroke education before discharge (95.6% vs 83.4%). Conclusions: A BTS collaborative learning and campaign model can improve the guideline adherence of stroke. The GWTG-Stroke can be successfully applied to other countries outside the United States.

scholarly journals Resolution of Inflammation is Disturbed in Macrophages of Diabetic Patients with Acute Ischemic Stroke

2021 ◽  
Author(s):  
Xin Tang ◽  
Zhijuan Miao ◽  
Lan Liu ◽  
Jiawei Zhang ◽  
Xiaolong Cai ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Diabetic Patients ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein ◽  
Resolution Function ◽  
Resolution Of Inflammation ◽  
Inflammatory Signals

Abstract Background: Inflammation plays an important role in diabetes mellitus (DM) and its related complications, including atherosclerosis and acute ischemic stroke (AIS). The mechanisms of excessive inflammation in DM are not fully understood. Specialized pro-resolving mediators (SPMs) are key regulators that promote resolution of inflammation. Unbalance of pro-resolving and pro-inflammatory signals may be the key pathogenesis in DM and DM-related diseases. We examined the resolution function in macrophages of DM patients with AIS.Methods: Macrophages were derived from peripheral blood mononuclear cells of AIS and none-AIS patients with or without DM. The cultured macrophages were treated with oxidized low-density lipoprotein. Resolution and inflammatory pathway markers were analyzed in the culture medium and cells. Results: In AIS patients, the ratios of SPMs to leukotriene B4 (LTB4) released by macrophages were decreased in those with DM compared to those without DM. Oxidized low-density lipoprotein treatment further reduced the ratios of SPMs/LTB4 in DM patients with AIS, but such a reduction was not observed in none-DM AIS patients. Analysis of M2/M1 polarization and MAPK/NFkB pathway markers also demonstrated un-resolved inflammation in macrophages of AIS patients with DM. Treatment with one of the SPMs, resolvin D2, rescued the resolution function and ameliorated inflammation in macrophages from these patients.Conclusions: Our data demonstrated that resolution of inflammation is disturbed by DM in macrophages of AIS patients, implicating a novel mechanism of un-resolved inflammation in DM-related vascular disorder. Exogenous SPMs treatment can rescue resolution and downregulate inflammatory signals, and may thus be beneficial in DM-related AIS.

scholarly journals Change of Plasma Oxidized Low-Density Lipoprotein Level Predicts Clinical Outcome at 90 Days for Patients with Acute Ischemic Stroke

2021 ◽  
Author(s):  
Xiaoli Yang ◽  
Wenbo Sun ◽  
Duanlu Hou ◽  
Tianyao Wang ◽  
Chen Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Infarct Volume ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein ◽  
Neurological Improvement ◽  
Level Change ◽  
Oxldl Level ◽  
Level Group

Abstract Objectives: To investigate the relationship between change of plasma oxidized low-density lipoprotein (oxLDL) level and clinical outcomes in patients with acute atherosclerosis related ischemic stroke. Methods: We recruited acute ischemic stroke patients within 3 days after onset consecutively. Plasma oxLDL level were measured on the second day after admission and before discharge. Initial stroke severity was assessed by the National Institutes of Health Stroke Scale(NIHSS) scores, and infarct volume was measured using diffusion weighted imaging (DWI) by ITK-SNAP software. Clinical outcomes were evaluated by neurological improvement at discharge and favorable functional prognosis at 90 days. Results: 207 patients were enrolled into this study. Compared with mild change of oxLDL level group, patients with significant change oxLDL level group were more likely to have higher ratio of neurological improvement at discharge(55.07% vs 14.49%) and favorable functional prognosis at 90 days(91.30% vs 55.07%). The DWI volumes in patients with different oxLDL level change groups were no statistical difference. In multivariable logistic regression, the degree of oxLDL level change was related with neurological improvement at discharge and favorable functional prognosis at 90 days. Compared to patients with mild change of oxLDL level, patients with significant change were more likely to have neurological improvement at discharge(OR=7.21,95%, 3.09-16.80, p <0.01) and favorable functional prognosis at 90 days (OR=6.67, 95%CI, 2.15-20.73, p <0.01).Conclusions: The degree of oxLDL level change is related to the neurological improvement at discharge and favorable functional prognosis at 90 days for patients with acute atherosclerosis related ischemic stroke, but not with infarct volume.

Reduction in the Ratio of Low-density Lipoprotein Cholesterol to Highdensity Lipoprotein Cholesterol is Associated with Increased Risks of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

2019 ◽  
Vol 16 (3) ◽  
pp. 266-272 ◽  
Author(s):  
Yanan Wang ◽  
Chenchen Wei ◽  
Quhong Song ◽  
Junfeng Liu ◽  
Yajun Cheng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hemorrhagic Transformation ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Stroke Patients ◽  
Increased Risk

Background and Purpose: Hemorrhagic transformation (HT) is a potentially serious complication in patients with acute ischemic stroke (AIS). Whether the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) is associated with HT remains unclear. Methods: Ischemic stroke patients within 7 days of stroke onset from January 2016 to November 2017 were included in this study. Lipid profiles were measured within 24h after admission. HT was determined by a second computed tomography or magnetic resonance imaging within 7 days after admission. Univariate and multivariate logistic regression analysis was used to assess the association between LDL-C/HDL-C and HT. Results: We enrolled 1239 patients with AIS (788 males; mean age, 64 ± 15 years), of whom 129 (10.4%) developed HT. LDL-C/HDL-C was significantly lower on admission in patients with HT than those without HT (2.00 ± 0.89 vs. 2.25 ± 1.02, P=0.009). The unadjusted odds ratio (OR) of low LDL-C/HDL-C for HT was 2.07 (95% confidence interval [CI] 1.42-3.01, P＜0.001). After adjustment for possible confounders, lower LDL-C/HDL-C (≤1.52) was significantly associated with HT (OR 1.53, 95% CI: 1.02-2.31, P=0.046). Similar results were observed between lower LDL-C (≤ 4 mmol/L) and HT (OR 4.17, 95% CI: 1.25-13.90, P=0.02). However, no significant association was found between HT and high HDL-C, low triglycerides or low total cholesterol. Conclusion: Lower LDL-C/HDL-C and LDL-C were significantly associated with increased risk of HT after AIS. Further investigations are warranted to confirm these findings and then optimize lipid management in stroke patients with lower LDL/HDL-C or LDL-C.

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