Prestroke statins use reduces oxidized low density lipoprotein levels and improves clinical outcomes in patients with atrial fibrillation related acute ischemic stroke

BMC Neurol. 2019 Oct 18;19(1):240. doi: 10.1186/s12883-019-1463-7.

Abstract

Background: Atrial fibrillation (AF) is a common cause of cerebral infarction, which could lead to endothelial dysfunction, increased reactive oxygen species (ROS) and oxidized low density lipoprotein (Ox-LDL).AF is associated with higher mortality and more severe neurologic disability. Statins may exert neuroprotective effects that are independent of LDL-C lowering. The purpose of our study was to investigate whether prestroke statins use could reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related acute ischemic stroke (AIS).

Methods: This was a multicenter prospective study that involved four medical centers, 242 AIS patients with AF were identified, who underwent a comprehensive clinical investigation and a 72 h-Holter electrocardiogram monitoring. All patients were divided into two groups: prestroke statins use and no prestroke statins use groups, who were followed up for 3 months. Plasma Ox-LDL levels were measured using enzyme-linked immunosorbent assay (ELISA) on admission and at 3 months. The outcome was death, major disability (modified Rankin Scale score ≥ 3), and composite outcome (death/major disability) at 3 months after AIS.

Results: One hundred thirty-six patients were in no prestroke statins use group, and 106 in prestroke statins use group. Plasma Ox-LDL levels were significantly lower in prestroke statins use than in no prestroke statins use on admission and at 3 months (P < 0.001). Plasma Ox-LDL levels on admission were associated with 3-month mortality [adjusted odds ratio (OR), 1.05; 95% confidence interval (CI), 0.99-1.12; P = 0.047]. In fully adjusted models, prestroke statins use was associated with reduced 3-month mortality [adjusted OR, 0.38; 95% CI, 0.16-0.91; P = 0.031)], major disability (adjusted OR, 0.38; 95% CI, 0.15-0.99; P = 0.047), and composite outcome (adjusted OR, 0.31; 95% CI, 0.17-0.74; P = 0.009).

Conclusions: Prestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.

Keywords: Acute ischemic stroke; Atrial fibrillation; Outcome; Oxidized low density; Statins.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / complications*
  • Cerebral Infarction / blood
  • Cerebral Infarction / etiology
  • Cerebral Infarction / physiopathology
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Lipoproteins, LDL / blood*
  • Lipoproteins, LDL / drug effects*
  • Male
  • Middle Aged
  • Odds Ratio
  • Prospective Studies
  • Stroke* / blood
  • Stroke* / etiology
  • Stroke* / physiopathology

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoproteins, LDL
  • oxidized low density lipoprotein