title: Statins in ischemic stroke: just low-density lipoprotein lowering or more?
abstract: BACKGROUND
  Statins have been shown to improve the functional outcome of patients after an ischemic stroke. We hypothesized that daily statin intake improves functional outcome after an acute ischemic stroke in patients with low-density lipoprotein (LDL) less than or equal to 100 mg/dL.
  
  
  METHODS
  This was a prospective cohort study during a 22-month period of patients presenting with an acute ischemic stroke and lipid profiles measured. The functional disability was determined using modified Rankin scale score (0-2 good outcome, 3-6 bad outcome) at discharge. Chi-square test for binary data and nonparametric tests for nonnormally distributed variables were used for analysis.
  
  
  RESULTS
  Of 508 patients, 207 presented with an LDL of 100 mg/dL or less and were included in the analysis. There was no significant difference in admission stroke severity (National Institutes of Health Stroke Scale [NIHSS]; P = .18), age (P = .31), and sex (P = .06) between those taking statins and not taking statins. Patients with LDL less than or equal to 100 mg/dL and taking statins (n = 100) were significantly more likely to have a good functional outcome (odds ratio 1.91; 95% confidence interval 1.05-3.47) when compared with those not on the medication. After adjusting for age, sex, and NIHSS, statin intake still predicted a better functional outcome (P < .0001).
  
  
  CONCLUSIONS
  Daily statin intake appears to result in a better functional outcome after an ischemic stroke in patients with ideal LDL levels (<or=100 mg/dL) before and after adjusting for age and stroke severity. Pleiotropic effects of statins may play a role in this.
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA. Stead.Latha@mayo.edu
authors.forename: Latha G
authors.initials: LG
authors.lastname: Stead
authors.forename: Lekshmi
authors.initials: L
authors.lastname: Vaidyanathan
authors.forename: Gautam
authors.initials: G
authors.lastname: Kumar
authors.forename: M Fernanda
authors.initials: MF
authors.lastname: Bellolio
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Smitha
authors.initials: S
authors.lastname: Suravaram
authors.forename: Sailaja
authors.initials: S
authors.lastname: Enduri
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Gilmore
authors.forename: Wyatt W
authors.initials: WW
authors.lastname: Decker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D001923:Brain Chemistry / Q000187:drug effects / Q000502:physiology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D019610:Cytoprotection / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D008077:Lipoproteins, LDL / Q000097:blood / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL; D018696:Neuroprotective Agents; D002784:Cholesterol