This Article Extract Full Text (PDF) All Versions of this Article: 39/11/e171    most recent STROKEAHA.108.527317v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reeves, M. J. Search for Related Content PubMed Articles by Reeves, M. J.

(Stroke. 2008;39:e171.)
© 2008 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Tsuda

Department of Epidemiology, Michigan State University, East Lansing, Mich

Arshad Majid, MD

Department of Neurology & Ophthalmology, Michigan State University, East Lansing, Mich

Bradley S. Jacobs, MD

Division of Neurology, Department of Internal Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio

for the Paul Coverdell National Acute Stroke Registry Michigan Prototype Investigators
Response:

We would like to thank Dr Tsuda for his interest in our recent publication which showed a difference in the effect of preadmission statins on ischemic stroke outcomes between blacks and whites.¹ Dr Tsuda provides a good summary for the role that statins may play in affecting NO-mediated endothelial and vascular function. Dr Tsuda goes on to speculate that racial differences in NO production might explain, in part, the differential effect of statins observed in our study and enquires about the endothelial function in our study subjects. Unfortunately, we did not obtain measures of endothelial function within our hospital-based stroke registry and so are unable to determine whether endothelial function varied by race.

There is increasing understanding of the molecular and genetic basis for ethnic differences in drug metabolism and therapeutic effects.² Clearly, further research on the underlying biological mechanisms for racial differences in statin effects—both the direct-lipid related and pleiotropic effects—is a fertile area of study. For example, Krauss et al³ recently identified a race-by-genotype interaction involving 2 polymorphisms in the gene encoding 3-hydroxyl-3-methylglutaryl-3 coenzyme A reductase (HMGCR). Blacks who carried the H2 and H7 alleles had a poorer LDL-C–lowering response to simvastatin than noncarriers. Such studies make an important contribution to determining the true clinical significance of the differences we observed in stroke outcomes.

Acknowledgments

Disclosures

None.

References

1. Reeves MJ, Gargano JW, Luo Z, Mullard AJ, Jacobs BS, Majid A. Effect of pretreatment with statins on ischemic stroke outcomes. Stroke. 2008; 39: 1779–1785.[Abstract/Free Full Text]

2. Xie HG, Kim RB, Wood AJ, Stein CM. Molecular basis of ethnic differences in drug disposition and response. Annu Rev Pharmacol Toxicol. 2001; 41: 815–850.[CrossRef][Medline] [Order article via Infotrieve]

3. Krauss RM, Mangravite LM, Smith JD, Medina MW, Wang D, Guo X, Rieder MJ, Simon JA, Hulley SB, Waters D, Saad M, Williams PT, Taylor KD, Yang H, Nickerson DA, Rotter JI. Variation in the 3-hydroxyl-3-methylglutaryl coenzyme a reductase gene is associated with racial differences in low-density lipoprotein cholesterol response to simvastatin treatment. Circulation. 2008; 117: 1537–1544.[Abstract/Free Full Text]

This Article Extract Full Text (PDF) All Versions of this Article: 39/11/e171    most recent STROKEAHA.108.527317v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Reeves, M. J. Search for Related Content PubMed Articles by Reeves, M. J.