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(Stroke. 2009;40:3413.)
© 2009 American Heart Association, Inc.

Editorials

Statins Prevent Stroke Recurrences... But Can They Improve Stroke Outcome?

Alejandro A. Rabinstein, MD

From the Mayo Clinic, Rochester, Minn.

Correspondence to Alejandro A. Rabinstein, MD, Mayo Clinic, 200 First Street SW, Rochester, MN 55905. E-mail rabinstein.alejandro@mayo.edu

Key Words: statins • stroke • outcome • severity

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 3526–3531.

First, multiple studies firmly established the value of statins in reducing the risk of ischemic stroke among patients with cardiovascular disease.¹ Then the truly seminal Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial showed that high-dose atorvastatin reduced the risk of subsequent stroke in patients without known coronary artery disease who had a recent stroke or transient ischemic attack before enrollment.² Now, in this issue of Stroke, the SPARCL investigators present data suggesting that high-dose statin might also reduce the severity of recurrent strokes.³ Can it be true that statins may not only prevent progression of vascular disease, but also be neuroprotectants or enhance recovery from neurological injury?

There is convincing experimental evidence indicating that statins have various potentially neuroprotective properties, including amelioration of glutamate-mediated excitotoxicity, attenuated production of reactive oxygen species, upregulation of endothelial nitric oxide synthase with favorable effects on the microcirculation, diminished inflammatory reaction by modulation of the cytokine response, and promotion of angiogenesis, which could improve the availability of collateral vessels.^4–9 Flow in the microcirculation could also be enhanced by statins due to antiplatelet and profibrinolytic effects.^10,11 Furthermore, statins could positively impact brain regeneration by stimulating neurogenesis and angiogenesis.⁴

However, the promise of neuroprotection and improved neurological recovery from these pleiotropic actions of statin drugs has not been consistently supported by the results of observational studies assessing the effect of previous statin treatment on ischemic stroke outcome. Although some studies suggested that previous statin therapy could improve . . . [Full Text of this Article]

Related Article:

Statin Treatment and Stroke Outcome in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Trial

Larry B. Goldstein, Pierre Amarenco, Justin Zivin, Michael Messig, Irfan Altafullah, Alfred Callahan, Michael Hennerici, Mary J. MacLeod, Henrik Sillesen, Richard Zweifler, K. Michael, A. Welch on behalf of the SPARCL Investigators
Stroke 2009 40: 3526-3531. [Abstract] [Full Text] [PDF]