Stroke severity and outcomes for octogenarians receiving statins

Pre-exposure to 3-hydroxy-3-methylgutaryl-coenzyne A reductase inhibitors (statins) appears to improve outcomes in patients with acute ischemic stroke (AIS). Whether this extends to patients over 80 is not known. Patients ≥80 years of age with AIS were retrospectively reviewed from the stroke registry of a tertiary stroke center. Pre-admission statin use, demographics, vascular risk factors, and comorbid conditions were assessed. Primary outcomes were admission National Institutes of Health Stroke Scale (NIHSS) scores and in-hospital mortality/discharge to hospice, and secondary outcomes included subsequent intracerebral hemorrhage (ICH) and modified Barthel index (mBI) at 3 months. Multivariable logistic regression was used to evaluate the association between pre-admission statin use and outcomes among elderly patients. Among 804 patients ≥80, those taking statins prior to AIS admission were overall younger, were more likely to have hypertension, coronary artery disease, diabetes, hyperlipidemia, and were more likely to be on an antiplatelet, but less likely to receive treatment with IV tissue plasminogen activator (tPA). Patients on statin had lower stroke severity (NIHSS > 16: 21.9% vs. 27.6%) and in-hospital mortality/discharge to hospice (22.8% vs. 27.6%), but neither was significant. There was no difference in ICH (1.2% vs. 1.9%), and patients on statins had a non-significant trend toward less disability on mBI (27.5% vs. 35.7%). Pre-admission statin use did not show a statistical difference in either outcome, but it did show a trend toward lower stroke severity and improved short-term outcomes. In addition, our study suggests that statins may be safe in elderly stroke patients and may not increase the risk of ICH.     

阿托伐他汀抑制二尖瓣置换术后患者大内皮素及氮末端脑钠肽原上调

目的评价术前给予负荷量阿托伐他汀对二尖瓣置换术后患者大内皮素（big-ET）及氮末端脑钠肽原（NT—proBNP）的影响。方法50例行二尖瓣置换术的患者,随机分为阿托伐他汀负荷组和安慰剂组,每组各25例。阿托伐他汀组术前12小时给予阿托伐他汀80mg口服,安慰剂组对应时间点给予安慰剂口服。分别于术前1d、术后1d、术后3d、术后7d留取静脉血,检测血中big—ET及NT—proBNP。结果阿托伐他汀组和安慰剂组术前血浆bigET-1和NT—proBNP的浓度均无差别（P〉0．05）,术后1d．3d．7d均小于安慰剂组（P〈0．05）。结论术前给予负荷量阿托伐他汀可抑制二尖瓣置换术后big-ET及NT～proBNP上调。     

血管紧张素Ⅱ受体拮抗剂与他汀对慢性充血性心衰患者左心室重构的影响

【目的】了解血管紧张素Ⅱ受体拮抗剂(angiotensinⅡreceptor blocker,ARB)和他汀对左心室重构的影响,并对比两者的作用。【方法】将58名cCHF患者随机分为3组:对照组(n=14),给予标准化抗心衰治疗(利尿剂,洋地黄,ACEI);ARB组(n=23),标准化治疗+厄贝沙坦;他汀组(n=21),标准化治疗+阿托伐他汀。治疗持续6个月。治疗前后用超声心动图评估左心室功能及重构参数,并比较各组治疗对左心室重构的影响。【结果】(1)三组受试对象的LVEF均较治疗前升高(P<0.05);(2)干预后ARB组与对照组相比左室重构指数下降:(2.09±0.24)vs.(2.54±0.12)(P<0.05);(3)干预后他汀组与对照组相比左室重构指数下降:(2.14±0.18)vs.(2.54±0.12)(P<0.05);(4)干预后ARB组与他汀组相比左室重构指数无统计学差异。【结论】ARB和他汀都均具有明显改善左心室功能和逆转左心室重构的作用。     

Statin plus ezetimibe treatment in clinical practice: the SI-SPECT (Slovenia (SI) Statin Plus Ezetimibe in Cholesterol Treatment) monitoring of clinical practice study

ABSTRACT

Background: Poor results from lipid-lowering therapy are mainly due to inadequate dosing and increased adverse effects with high-dose statin monotherapy or drug combinations.

Objectives: The SI-SPECT (Slovenia (SI) Statin Plus Ezetimibe in Cholesterol Treatment) study evaluated the effectiveness of either ezetimibe (EZE) 10?mg as monotherapy or co-administered with on-going statin treatment (S?+?EZE) in clinical practice.

Design and methods: A total of 1053 dyslipidaemic patients (52% men, age 60.3 years, 42.9% with CHD, 32.0% with diabetes mellitus and 69.6% with hypertension) were enrolled. The majority (n?=?986; 93.6%) were treated with EZE as ‘add-on’ to their already prescribed statin, the rest only received EZE (n?=?67).

Main outcome measures: Baseline lipid levels were compared with those obtained 16 weeks after initiating treatment.

Results: Total (TC) and low density lipoprotein cholesterol (LDL-C), as well as triglycerides (TG) decreased significantly with S?+?EZE (by 25.3%, 31.4% and 28.9%, respectively; p?<?0.0001 for all comparisons), while monotherapy with EZE resulted in a decrease of 20.8% for TC (?p?<?0.0001), 28.0% for LDL-C (?p?<?0.0001) and 28.8% for TG (?p?=?0.016). At the end of the study 43.9% of patients achieved target TC (<?5.0?mmol/L for primary prevention and <?4.5?mmol/L for secondary prevention), 50.5% target LDL-C (<?3.0?mmol/L for primary prevention and <?2.5?mmol/L for secondary prevention) and 61.6% target TG (<?2.0?mmol/L). The overall incidence of adverse effects during the treatment period, and probably related to EZE use, was low (n?=?6, 0.6% of patients).

Conclusions: (1) S?+?EZE combination therapy was effective and safe irrespective of the statin used, (2) the S?+?EZE combination resulted in significantly more patients reaching their recommended target lipid levels and (3) the lipid-lowering efficacy of EZE in monotherapy as well as of the S?+?EZE combination was related to initial lipid values. The much greater decrease of TG than expected could be, at least in part, due to better control/compliance regarding diet and drug treatment during the study and adherence to the need for an overnight fast before sampling.     

Lipid-lowering therapy with statins for the primary and secondary prevention of cardiovascular disease

Cardiovascular disease (CVD) still ranks as the top cause of mortality worldwide. Lipid-modifying therapy has revolutionized the treatment of the disease and is partly responsible for the recent decline in deaths due to CVD. Treatment strategies have evolved since the introduction of the earlier lipid-lowering agents (fibrates, niacin, bile acid resins) to the advent of statins, which have become the standard drugs in cholesterol therapy. The strategy of using high-intensity statin therapy as the initial treatment approach in high-risk individuals, rather than focusing on specific cholesterol levels alone, remains a subject of debate.     

Statin use and medically attended acute respiratory illness among influenza vaccine recipients

BackgroundPrevious studies have suggested that statins decrease influenza vaccine effectiveness and increase risk of medically attended acute respiratory illness (MAARI).ObjectivesTo examine the association of incident statin use and MAARI in a cohort of influenza vaccine recipients.MethodsThis retrospective cohort study evaluated influenza vaccine recipients within the Tricare population. The primary outcome compared MAARI incidence during the follow-up period in a propensity score-matched cohort of incident statin users and statin non-users. Secondary analysis included propensity score-adjusted comparisons between incident statin users and statin non-users in the entire cohort and prespecified sub-cohorts with and without comorbidities. The propensity score was derived from 72 variables encompassing demographics, medical history, comorbidities, medication use, and healthcare utilization.ResultsMAARI incidence in statin users was similar to non-users in the propensity score-matched cohort (odds ratio [OR] 0.92; 95% confidence interval [CI] 0.84–1.01). In contrast, statin users with lower comorbidity had lower OR for MAARI compared to non-users (Charlson Score zero cohort: 0.85 [CI 0.74–0.98]; No Diabetes cohort: 0.88 [CI 0.80–0.96]).ConclusionIncident statin use was not associated with increased MAARI incidence and may be associated with lower incidence of MAARI in those with less comorbidity. This study thus offers reassurance regarding the effectiveness of the influenza vaccine in statin users.     

Efficacy and safety of alirocumab in statin-intolerant patients over 3 years: open-label treatment period of the ODYSSEY ALTERNATIVE trial

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他汀类药物降低急性冠脉综合征外周血Th1／Th2细胞比率

目的探讨在急性冠脉综合征（ACS）中应用他汀类药物对Th1和Th2细胞亚群的影响。方法将56例ACS按照入院前是否应用他汀类药物分为应用他汀组（A组，30例）和未使用他汀组（B组，26例），用流式细胞术检测入院时Th1和Th2细胞比例并进行两组间比较；入院治疗（B组加用他汀）1月后，再次复查和比较Th1和Th2细胞，同时在B组将治疗后和治疗前结果进行自身对比。结果A组在入院时Th1细胞比例较B组低，Th2细胞比例无显著性差异；经加用他汀治疗1月后，两组间Th1和Th2细胞比例均无显著性差异。B组治疗后Th1细胞较治疗前有显著降低。结论在ACS中应用他汀类药物治疗能降低Th1细胞激活程度，改善Th1／Th2细胞比值的不平衡。