Low-dose statin pretreatment improves function and prognosis of recurrent ischemic stroke patients

I know this is pretreatment so it doesn't apply to us. But has your doctor applied this yet?

1. Statins.

tested in rats from 2003

http://Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke Statins induce angiogenesis, neurogenesis, and synaptogenesis after stroke  

Simvastatin Attenuates Stroke-induced Splenic Atrophy and Lung Susceptibility to Spontaneous Bacterial Infection in Mice

Or,

Simvastatin attenuates axonal injury after experimental traumatic brain injury and promotes neurite outgrowth of primary cortical neurons 

October 2012

tested in humans, March, 2011

http://www.medwirenews.com/39/91658/Stroke/Acute_statin_therapy_improves_survival_after_ischemic_stroke.html

And now lost even to the Wayback Machine

The latest here:

Low-dose statin pretreatment improves function and prognosis of recurrent ischemic stroke patients

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Chaohua Cui*, Shuju Dong*, Ning Chen, ...

First Published June 7, 2020 Research Article

https://doi.org/10.1177/1756286420920078

Article information

Abstract

Background:

Statins are effective in improving the prognosis of stroke patients. In clinical practice, low-dose statins are often administered to stroke patients in Asian countries but their effects on the prognosis of recurrent ischemic stroke patients are still unclear.

Methods:

Data of consecutive recurrent ischemic stroke patients were prospectively collected. The National Institutes of Health Stroke Scale (NIHSS) of admission and discharge and the modified Rankin scale (mRs) of 90 days after stroke onset were adopted to evaluate primary outcomes. Secondary outcomes included the subgroup analysis.

Results:

Among 219 patients (mean age 65.41 ± 11.58 years), 150 (68.5%) were male. The low-dose statin group had a higher percentage of milder stroke at admission (p < 0.001) and discharge (p < 0.001), and favorable functional outcome at 90 days (p < 0.001). Univariable regression analysis showed that the use of low-dose statins was inversely associated with higher discharge NIHSS [odds ratio (OR) = 0.36, p = 0.009] and higher mRs at 90 days (OR = 0.230, p < 0.001). Multivariable logistic regression analysis revealed that low-dose statins also had a significantly inverse association with higher mRs at 90 days (OR = 0.098, p = 0.049). According to subgroup analysis, a significant effect was found in the good-persistency subgroup (NIHSS score at discharge: OR = 0.051, p = 0.004; mRs score at 3 months: OR = 0.053, p = 0.005), but not in the poor-persistency subgroup.

Conclusion:

Low-dose statin pretreatment alleviated stroke severity and improved functional outcomes of recurrent stroke patients.

Keywords low-dose statins, prognosis, recurrent ischemic stroke, severity

Introduction

Stroke is the second most prevalent illness that causes death and disability globally.¹ Statins can effectively lower the occurrence and recurrence risk of stroke,^2,3 and statin pretreatment is related to better neurological function and prognosis in patients with acute ischemic stroke.^4,5
Previous studies were mostly conducted in western countries and whether evidence could be applied to Asian patients remains uncertain. In western countries, high-dose statins are usually prescribed and recommended in guidelines,⁶ whereas in Asian countries, low-dose statins are mostly used in clinic practice. Statins can lower low-density lipoprotein (LDL-C) values and their efficacy is dose dependent;³ however, it is uncertain whether the effects of low-dose statins are comparable with those of high-dose statins.
At present, low-dose statins are used for the prevention of stroke. The MEGA study revealed that low-dose pravastatin is nonsignificantly related to the incidence of stroke among Japanese.⁷ The J-STARS study indicated that low-dose pravastatin reduced the recurrence of atherothrombotic stroke in Japanese patients.⁸ Our previous retrospective study showed that stroke patients pretreated with low-dose statin in western China had better functional outcomes and prognosis for primary prevention.⁹ However, the retrospective study design could not contain data on all risk factors, which may cause bias for statistical results. Further, the study did not include recurrent stroke patients. Therefore, whether low-dose statins exert effects on the functional outcomes of recurrent ischemic stroke patients is uncertain.
The present study investigated the relationship between low-dose statin pretreatment and prognosis for recurrent ischemic stroke patients, and explored whether different risk factors could affect the effects of statins in Asian patients with recurrent stroke.

Stroke Rounds: Statin Users Have Better Outcomes

But they didn't compare it to these other pretreatment options. So as far as research is concerned this is pretty worthless. Damn it all,  does no one in stroke ever think at all? Do they not know about this other research?

High altitudes for Training the Brain to Survive Stroke.

 

Neurovascular Mechanisms of Ischemia Tolerance Against Brain Injury

 

Prior Cannabis Use Is Associated with better Outcome after Intracerebral Hemorrhage

 

Vaccine shows potential to protect the brain before a stroke

 

Mice were pretreated with genistein (2.5, 5, and 10mg/kg) or vehicle orally once daily for 14 consecutive days before MCA.

  

Numerous reports of lower in-hospital mortality among smokers versus nonsmokers 

Clinically established low doses of memantine should be considered for patients 'at risk' of stroke 

 

Pretreatment of fish oil supplementation in a rat model of multiple mild traumatic brain injuries.  

And the fairly worthless one-off here:

Stroke Rounds: Statin Users Have Better Outcomes

Preexisting statin use was associated with better outcomes in patients with acute ischemic stroke (AIS) from large artery atherosclerosis (LAA), an international, multicenter study showed.
Neurologic improvement during hospitalization was greater in patients on a statin and taking it in the days prior to stroke than in those not taking a statin (66.7% versus 38.9%; P=0.004), Georgios Tsivgoulis, MD, PhD, of the University of Tennessee Health Science Center in Memphis, and colleagues found.
Statin use before stroke was independently associated with favorable functional outcome using a modified Rankin Scale (mRS) score of 0-1 (odds ratio 2.44%; 95% confidence interval 1.07-5.53), the investigators reported online in Neurology.
Patients with LAA who received statins prior to the onset of AIS also had a lower risk of stroke recurrence (hazard ratio 0.11; 95% CI 0.02-0.46) at 30 days and a lower risk of 1-month mortality (HR 0.24; 95% CI: 0.08-0.75), the study showed.
"Our findings provide preliminary observational evidence underscoring a potentially beneficial effect of statins in improving early stroke outcomes in AIS patients with an underlying atherothrombotic mechanism," the researchers wrote. "This hypothesis deserves to be further tested in the setting of a randomized controlled trial."
Results from this study lend support to current American Heart Association/American Stroke Association recommendations for continuation of statin treatment during the acute period in pretreated AIS patients, pointed out the investigators. However, they emphasized, in the absence of phase III, randomized controlled trial data on the safety and efficacy of statins during the first 30 days following stroke, the observational study design and the short follow-up "does not allow us to infer any causal associations between statin pretreatment and improved outcomes in patients with acute LAA."
While this study provides "key data" and adds to the growing evidence about the benefits of statin use in AIA, "the results should be interpreted with caution because of potential residual confounding," Andreas Charidimou, MD, PhD, of the Massachusetts General Hospital Stroke Research Center in Boston, and Áine Merwick, MB, PhD, of the Westminster NHS Foundation Trust in London, cautioned in an accompanying editorial.
"Unlike strong evidence supporting statin use in cardiovascular risk reduction and acute myocardial ischemia, their effects on cerebral tissue and potential benefits on stroke outcomes remain poorly understood and under-studied," said the editorialists. "The only current stroke-specific indication for statin use is atorvastatin (Lipitor) for secondary stroke prevention," they noted.
Charidimou and Merwick agreed on "the urgent need for a large randomized clinical trial of high-dose statin treatment in the acute stroke setting."
Statin pretreatment may play a role in symptomatic and asymptomatic patients undergoing carotid endarterectomy as well as in the periprocedural and postprocedural outcomes of patients undergoing carotid artery stenting procedures, they pointed out. In addition, data from this study may have implications for the management of asymptomatic carotid disease as well as interpretive value for ongoing studies such as the European Carotid Surgery Trial 2, said Charidimou and Merwick.
Tsivgoulis' study prospectively evaluated 516 consecutive first-ever AIS patients with LAA from seven tertiary stroke care centers from June 2011 to June 2014. The mean age was 65 years and 60.8% were male. The median NIHSS score was 9 points. LAA was diagnosed by TOAST criteria.
Statin pretreatment was documented in 192 (37.2%) patients. Information on the duration, dosage, and type of prestroke statin therapy was not collected, the authors noted.

Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke

I guess I'm supposed to be smart enough to understand what statin pretreatment is since it is never explained. 

Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke

Tsivgoulis G¹, Kadlecová P², Kobayashi A², Czlonkowska A², Brozman M², Švigelj V², Csiba L², Kõrv J², Demarin V², Vilionskis A², Jatuzis D², Katsanos AH², Rudolf J², Krespi Y², Mikulik R².

Author information

Abstract

BACKGROUND AND PURPOSE:

A recent meta-analysis investigating the association between statins and early outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) indicated that prestroke statin treatment was associated with increased risk of 90-day mortality and symptomatic intracranial hemorrhage. We investigated the potential association of statin pretreatment with early outcomes in a large, international registry of AIS patients treated with IVT.

METHODS:

We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke-East registry (SITS-EAST) registry on consecutive AIS patients treated with IVT during an 8-year period. Early clinical recovery within 24 hours was defined as reduction in baseline National Institutes of Health Stroke Scale score of ≥10 points. Favorable functional outcome at 3 months was defined as modified Rankin Scale scores of 0 to 1. Symptomatic intracranial hemorrhage was diagnosed using National Institute of Neurological Disorders and Stroke, European-Australasian Acute Stroke Study-II and SITS definitions.

RESULTS:

A total of 1660 AIS patients treated with IVT fulfilled our inclusion criteria. Patients with statin pretreatment (23%) had higher baseline stroke severity compared with cases who had not received any statin at symptom onset. After adjusting for potential confounders, statin pretreatment was not associated with a higher likelihood of symptomatic intracranial hemorrhage defined by any of the 3 definitions. Statin pretreatment was not related to 3-month all-cause mortality (odds ratio, 0.92; 95% confidence interval, 0.57-1.49; P=0.741) or 3-month favorable functional outcome (odds ratio, 0.81; 95% confidence interval, 0.52-1.27; P=0.364). Statin pretreatment was independently associated with a higher odds of early clinical recovery (odds ratio, 1.91; 95% confidence interval, 1.25-2.92; P=0.003).

CONCLUSIONS:

Statin pretreatment seems not to be associated with adverse outcomes in AIS patients treated with IVT. The effect of statin pretreatment on early functional outcomes in thrombolysed AIS patients deserves further investigation.