Abstract
Backgrounds Stroke is the leading cause of death and long-term disability. Oxidative stress is elevated during occurrence of acute ischemic stroke (AIS). Soluble LOX-1 (sLOX-1) and NO are used as biomarkers for vascular oxidative stress that can reflect stabilization of atherosclerotic plaque. Previous study showed that simvastatin can reduce oxidative stress and LOX-1 expression. Objectives To evaluate neurological outcomes and serum sLOX-1 and NO levels in patients with AIS treatment with low dose 10 mg/day and high dose 40 mg/day of simvastatin. Methods 65 patients with AIS within 24 hours after onset were randomized to treatment with simvastatin 10 mg/day or 40 mg/day for 90 days. Personal data and past history of all patients were recorded at baseline. The blood chemistries were measured by standard laboratory techniques. Serum sLOX-1 and NO levels and neurological outcomes including NIHSS, mRS, and Barthel index were tested at baseline and Day 90 after simvastatin therapy. Results Baseline characteristics were not significantly different in both groups except history of hypertension. Serum sLOX-1 and NO levels significantly reduce in both groups (sLOX-1 = 1.19 ± 0.47 and 0.98 ± 0.37 ng/ml; NO = 49.28 ± 7.21 and 46.59 ± 9.36 μmol/l) in 10 mg/day and 40 mg/day simvastatin groups, respectively. Neurological outcomes including NIHSS, mRS, and Barthel index significantly improve in both groups. However, no difference in NO level and neurological outcomes was found at 90 days after treatment as compared between low dose 10 mg/day and high dose 40 mg/day of simvastatin. Conclusion High-dose simvastatin might be helpful to reduce serum sLOX-1. But no difference in clinical outcomes was found between high- and low-dose simvastatin. Further more intensive clinical trial is needed to confirm the appropriate dosage of simvastatin in patients with acute ischemic stroke. This trial is registered with ClinicalTrials.gov ID: NCT03402204.
Highlights
Ischemic stroke is the main etiology of disability in senile population and remains the third most common cause of death in the world [1]
There were no significant differences in age, systolic or diastolic blood pressure, blood sugar, lipid profile, NIHSS score, and treatment with intravenous route (IV) recombinant tissue plasminogen activator (rtPA) between the two groups but there was significant difference in medical history of hypertension
After 90 days of simvastatin treatment, serum soluble LOX-1 (sLOX-1) level was significantly reduced in simvastatin 40 mg/day group (P = 0.04) but there was no difference in nitric oxide (NO) level as compared between simvastatin 10 mg/day and simvastatin 40 mg/day group (Table 3 and Figure 1)
Summary
Ischemic stroke is the main etiology of disability in senile population and remains the third most common cause of death in the world [1]. Stroke has been the common cause of mortality in Thailand for decades [2,3,4]. Oxidative stress is defined as a disturbance in the prooxidant-antioxidant balance in favor of the prooxidant, leading to potential damage [7]. Oxidative stress is elevated during occurrence of acute ischemic stroke (AIS) [8, 9]. Previous study found that oxidized-low density lipoprotein (ox-LDL) and oxidative stress induce production of lectin-like oxidized low density lipoprotein receptor-1 (LOX1) and cleavage some extracellular parts of LOX-1 into blood circulation, and it is called soluble LOX-1 (sLOX-1) [10]. The sLOX-1 is used for biomarker in patients with myocardial
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
