Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, February 26, 2017

Early Statin Start After Stroke No Better for Outcomes

But these positives:

Could statins help cut Alzheimer's risk?

 

Stroke Rounds: Statin Users Have Better Outcomes

High-Dose Atorvastatin after Stroke or Transient Ischemic Attack

 


Early Statin Start After Stroke No Better for Outcomes

Pleiotropic effects didn't pan out acutely in small randomized trial
  • by
    Senior Associate Editor, MedPage Today
HOUSTON -- Statin therapy from day 1 for acute stroke patients with high cholesterol or already on one did not improve outcomes, the ASSORT randomized trial showed.
That early start to lipid-lowering treatment did not shift modified Rankin Scale scores compared with statin therapy delayed to day 7 post-stroke (adjusted common OR 0.84, 95% CI 0.53-1.3), Shinichi Yoshimura, MD, PhD, of Hyogo College of Medicine in Nisinomiya City, Japan, reported here at the International Stroke Conference.
Likewise there were no differences in change in NIH Stroke Scale scores to day 7, in unstable angina, large vessel or peripheral artery disease requiring treatment, new ischemic stroke, or subarachnoid or cerebral hemorrhage.
Safety was similar for death, overall adverse events, musculoskeletal events, and liver enzymes.
Despite the lack of benefit in this admittedly-underpowered, multicenter, open-label trial of 270 patients, the researchers weren't ready to give up on the possibility of pleiotropic benefit in acute stroke, suggesting instead using higher doses in more severe stroke in the next trial. ASSORT included mainly mild stroke, because patients had to be able to swallow oral medication soon after stroke. Daily doses used were 20-mg atorvastatin (Lipitor), 4-mg pitavastatin (Livalo), or 5-mg rosuvastatin (Crestor).
Some prior studies including a much larger Korean stroke registry found benefit, "so I think there's something here," agreed Philip Gorelick, MD, MPH, of the Michigan State University College of Human Medicine in Grand Rapids and an American Stroke Association spokesperson on a press conference panel.
However, there are other reasons than pleiotropic benefits to give a statin early after a stroke, commented conference chair Bruce Ovbiagele, MD, of the Medical University of South Carolina in Charleston, who also moderated the press briefing.
"While this might not have shown that it was effective in terms of the index stroke, you did notice that there's a difference in terms of LDL reduction at 21 days in the early dosing. So to me this is an endorsement of the early administration as a way to initiate secondary prevention early," he said.
Most U.S. centers do already start statin therapy for patients who meet treatment criteria at least some time during the index hospitalization, Ovbiagele noted.
Even if the evidence on earlier timing isn't solid, "if there's no harm and you could potentially start the prevention regimen early and optimize adherence in the community as much as possible, why not?" he said.
Yoshimura disclosed relationships with Sionogi Pharmaceutical, Takeda, Bristol-Meyers, Mitsubishi Tanabe Pharma, Sanofi, Boehringer-Ingelheim, Otsuka Pharmaceutical, Bayer, and Pfizer.

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