Journal Article10.1056/NEJMOA061894
High-dose atorvastatin after stroke or transient ischemic attack.
Pierre Amarenco,Julien Bogousslavsky,Callahan A rd,Larry B. Goldstein,M.G. Hennerici,Amy E. Rudolph,Henrik Sillesen,Lisa Simunovic,Michael Szarek,K M Welch,Justin A. Zivin,Stroke Prevention by Aggressive Reduction in Cholesterol Levels (Sparcl) Investigators +11 more
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TL;DR: In this paper, the authors showed that 80 mg of atorvastatin per day reduced the overall incidence of stroke and cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke.
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Abstract: Background Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established. Methods We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke. Results The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin. Conclusions In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).
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Stroke--an equal opportunity for the initiation of statin therapy.
TL;DR: Given the disparity in the numbers of cerebrovascular and cardiovascular clinical trials and the similarities in the interventions tested, it seems that stroke neurologists have had to peer at clinical-trial results over the shoulders of their cardiologist colleagues so often that they are at risk for chronic neck ailments.
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Lipid Association of India (LAI) expert consensus statement on management of dyslipidaemia in Indians 2017: part 2
S S Iyengar,Raman Puri,S. N. Narasingan,Devaki Nair,Vimal Mehta,Jagdish C. Mohan,Subhash Kumar Wangnoo,J. J. Dalal,V. Jha,S. Puri,Anoop Misra,Mradul Kumar Daga,M. S. K. Varma,Sanjiv Jasuja,S. D. Upadhyaya,Ravi R Kasliwal,Manish Bansal,Rahul Mehrotra,A. Jain,Kewal K. Talwar,Rajesh Rajput,Akshyaya Pradhan,Shashi Seth,Dheeraj Kapoor,R. P. Melinkeri,Sivasubramanian Ramakrishnan,Narendra N. Khanna,Rajesh Khadgawat,Altamash Shaikh,N. Kovalipati,N. Bordoloi,Abdul Hamid Zargar,Rajeev Agarwal,Ashu Rastogi,M. Chag,D Prabhakar,S. K. Mathur,Harmeet Singh Rehan,P. K. Sahoo,A.L. Dutta,A. D. Sharma,A. K. Pancholia,K. U. Natarajan,A. Mishra,K. K. Singh +44 more
TL;DR: These Lipid Association of India (LAI) recommendations refer to specific patient populations, including patients with heart failure, chronic kidney disease, non-alcoholic fatty liver disease, cerebrovascular disease, thyroid disorders, inflammatory joint diseases, familial hypercholesterolaemia and human immunodeficiency virus infection.
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Transporter-Mediated Delivery of Small Molecule Drugs to the Brain: A Critical Mechanism That Can Advance Therapeutic Development for Ischemic Stroke
TL;DR: Current knowledge on specific BBB transporters that can be targeted for improvement of ischemic stroke treatment are reviewed and state-of-the-art perspectives on the rationale for considering BBB transport properties during discovery/development of stroke therapeutics are provided.
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Drug eluting stents for symptomatic intracranial and vertebral artery stenosis.
Jeremy D. Fields,Bryan D. Petersen,Helmi L. Lutsep,Gary M. Nesbit,Kenneth C. Liu,Aclan Dogan,David S. H. Lee,Wayne M. Clark,Stanley L. Barnwell +8 more
TL;DR: Restenosis at the VO was less frequent than might have been expected from reports utilizing BMS, however, overall restenosis rates appeared higher than previously reported for patients with intracranial DES and comparable with restenotic rates for intrac Cranial BMS.
Aggressive statin treatment, very low serum cholesterol levels and haemorrhagic stroke: is there an association?
Vasilios G. Athyros,Konstantinos Tziomalos,Asterios Karagiannis,Anthony S. Wierzbicki,Dimitri P. Mikhailidis +4 more
TL;DR: Existing data suggest that low LDL-C levels during intensive statin treatment are not associated with an increased risk for haemorrhagic stroke, except in patients with a history of intracerebral haem orrhage, which is greatly outweighed by the protective effect against ischaemic stroke and CHD events.
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TL;DR: A survey was carried out on a number of 'untreated' cases seen shortly after the onset of a cerebral vascular accident, with particular reference to the presence of signs which had prognostic value, to enable the investigator to assess the results of specific forms of treatment.
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