Abstract
BackgroundAtrial 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).MethodsThis 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.ResultsOne 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).ConclusionsPrestroke statins use can reduce plasma Ox-LDL levels and improve clinical outcomes in patients with AF-related AIS.
Highlights
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
It is believed that prethrombotic forces, along with endothelial dysfunction and blood stasis of AF are the basis of thrombus formation and growth, when large thrombi embolize to the cerebral circulation, leading to severe cerebral infarction
In a recent study by Ko et al, that enrolled 1030 AF-related ischemic stroke patients followed up for 30 days, the authors aimed to observe the influence of prestroke statins use on functional outcome; the results showed that prestroke statins use among patients with AF-related ischemic stroke was associated with a 32% reduction in the risk of the stroke being severe at the time of discharge or decreased mortality at 30 days [34], but the limitation of this study was that the patients were followed up for a short time, only investigated clinical outcome at discharge and the 30-day mortality rate
Summary
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. 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). Strokes related to AF are associated with higher mortality and more severe neurologic disability [3,4,5,6]. Oxidized low density lipoprotein (Ox-LDL) has an important role in the pathogenesis of vascular atherosclerosis. It plays a pro-inflammatory and proatherogenic role by inducing endothelial dysfunction [7]. Data from studies on the predictive value of Ox-LDL levels for outcomes of ischemic stroke were scarce
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