title: Early High-dosage Atorvastatin Treatment Improved Serum Immune-inflammatory Markers and Functional Outcome in Acute Ischemic Strokes Classified as Large Artery Atherosclerotic Stroke: A Randomized Trial.
abstract: Statins have beneficial effects on cerebral circulation and brain parenchyma during ischemic stroke and reperfusion. The primary hypothesis of this randomized parallel trial was that treatment with 80 mg/day of atorvastatin administered early at admission after acute atherosclerotic ischemic stroke could reduce serum levels of markers of immune-inflammatory activation of the acute phase and that this immune-inflammatory modulation could have a possible effect on prognosis of ischemic stroke evaluated by some outcome indicators. We enrolled 42 patients with acute ischemic stroke classified as large arteries atherosclerosis stroke (LAAS) randomly assigned in a randomized parallel trial to the following groups: Group A, 22 patients treated with atorvastatin 80 mg (once-daily) from admission day until discharge; Group B, 20 patients not treated with atorvastatin 80 mg until discharge, and after discharge, treatment with atorvastatin has been started. At 72 hours and at 7 days after acute ischemic stroke, subjects of group A showed significantly lower plasma levels of tumor necrosis factor-α, interleukin (IL)-6, vascular cell adhesion molecule-1, whereas no significant difference with regard to plasma levels of IL-10, E-Selectin, and P-Selectin was observed between the 2 groups. At 72 hours and 7 days after admission, stroke patients treated with atorvastatin 80 mg in comparison with stroke subjects not treated with atorvastatin showed a significantly lower mean National Institutes of Health Stroke Scale and modified Rankin scores. Our findings provide the first evidence that atorvastatin acutely administered immediately after an atherosclerotic ischemic stroke exerts a lowering effect on immune-inflammatory activation of the acute phase of stroke and that its early use is associated to a better functional and prognostic profile.
authors.affiliation: From the Internal Medicine and Cardioangiology Ward (AT, DDR, RP, CM, VDC, IS, FC, AP), Dipartimento Biomedico di Medicina Interna e Specialistica; Department of Experimental Medicine and Clinical Neurosciences (VA), Clinical Neurology ward; Department of Experimental Medicine and Clinical Neurosciences (RM, DGI), Neurosurgical Section, University of Palermo; and School and Chair of Allergology, Dipartimento delle Emergenze e Trapianti d'Organo (DDB), University of Bari, Bari Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Tuttolomondo
authors.forename: Domenico
authors.initials: D
authors.lastname: Di Raimondo
authors.forename: Rosaria
authors.initials: R
authors.lastname: Pecoraro
authors.forename: Carlo
authors.initials: C
authors.lastname: Maida
authors.forename: Valentina
authors.initials: V
authors.lastname: Arnao
authors.forename: Vittoriano
authors.initials: V
authors.lastname: Della Corte
authors.forename: Irene
authors.initials: I
authors.lastname: Simonetta
authors.forename: Francesca
authors.initials: F
authors.lastname: Corpora
authors.forename: Danilo
authors.initials: D
authors.lastname: Di Bona
authors.forename: Rosario
authors.initials: R
authors.lastname: Maugeri
authors.forename: Domenico Gerardo
authors.initials: DG
authors.lastname: Iacopino
authors.forename: Antonio
authors.initials: A
authors.lastname: Pinto
mesh_terms: D000208:Acute Disease; D000368:Aged; D000069059:Atorvastatin / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D019040:E-Selectin / Q000096:biosynthesis; D005260:Female; D006801:Humans; D007249:Inflammation / Q000188:drug therapy* / Q000503:physiopathology; D018836:Inflammation Mediators / Q000378:metabolism*; D018799:Intercellular Adhesion Molecule-1 / Q000096:biosynthesis; D016753:Interleukin-10 / Q000096:biosynthesis; D053583:Interleukin-1beta / Q000096:biosynthesis; D015850:Interleukin-6 / Q000096:biosynthesis; D002537:Intracranial Arteriosclerosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D019007:P-Selectin / Q000096:biosynthesis; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis; D019010:Vascular Cell Adhesion Molecule-1 / Q000096:biosynthesis
chemical_list: D015415:Biomarkers; D019040:E-Selectin; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6; D019007:P-Selectin; D014409:Tumor Necrosis Factor-alpha; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1; D016753:Interleukin-10; D000069059:Atorvastatin