The association of statin therapy and high-sensitivity C‐reactive protein level for predicting clinical outcome in acute non-cardioembolic ischemic stroke
Highlights
► Statin therapy alters serum hs-CRP level in patient after acute ischemic stroke. ► Statin treatment is associated with good outcome after acute ischemic stroke. ► The hs-CRP level after ischemic stroke is a predictive factor of 3-month outcome.
Introduction
Inflammation plays an important role in the pathogenesis of acute ischemic stroke (IS) [1]. Previous researches suggest that post-stroke inflammatory responses may exacerbate tissue damage after cerebral infarction and contribute to the clinical outcome [2], [3]. Measuring the inflammatory biomarkers that reflect the degree of inflammation may help predict future cardiovascular event after acute IS. Although many inflammatory biomarkers have been reported to be useful in predicting clinical outcome after stroke [4], [5], [6], high-sensitivity C-reactive protein (hs-CRP) remains one of the most widely used in clinical practice [7], [8].
Statins, a 3-hydroxy 3-methyl-glutaryl coenzyme-A reductase inhibitor, is originally used as treatment of hypercholesterolemia [9]. Increasing evidence reveals that statins have anti-inflammatory effects in addition to their cholesterol-lowering effect [10], [11]. Statin therapy has been shown to reduce the severity of acute IS and improve its outcome [12], [13], [14], [15]. The JUPITER Study further demonstrates the primary prevention effect of rosuvastatin in apparently healthy persons without hyperlipidemia but with elevated hs-CRP levels [16].
A recent study reports that statin therapy is associated with reduced platelet activity and favorable clinical outcome in patients after acute IS [17]. However, the study does not show the effects of statins on serum hs-CRP level after IS. Therefore, this prospective cohort study aimed to examine the role serum hs-CRP levels in predicting the outcome of IS patients and the impact of statin therapy on serum hs-CRP level and its clinical outcome.
Section snippets
Study participants
Consecutive acute non-cardioembolic IS patients, age between 18 and 80 y, who were admitted to the Neurology Department of Chang Gung Memorial Hospital-Kaohsiung from July 2010 to June 2011 were evaluated. Acute IS was defined as acute onset loss of focal cerebral function persisting for at least 24 h. The diagnosis of stroke was based on clinical presentation, neurologic examination, and results of brain magnetic resonance imaging (MRI) with diffusion-weighted images (DWI). The etiologic
Baseline characteristics between the patient groups
Of the 50 patients in the statin group, 16 used atorvastatin (6 cases with 40 mg/day and 10 cases with 10 mg/day), 10 fluvastatin (80 mg/day), 16 rosuvastatin (14 cases with 10 mg/day and 2 cases with 5 mg/day), and 8 simvastatin (6 cases with 40 mg/day and 2 cases with 20 mg/day). They took their first dose of statin within 72 h after the onset of stroke. The other 50 patients did not receive statin therapy (non-statin group) before and after the stroke event. Based on the demographic data of the
Discussion
The present study has 3 major findings. First, statin therapy significantly alters serum hs-CRP level in patient after acute IS. Second, patients with statin therapy after acute IS have a higher percentage of good prognosis. Third, hs-CRP level during acute phase of IS (within 48 h) is significantly and independently predictive of the three-month outcome.
As an inflammatory biomarker, hs-CRP independently predicts future cardiovascular events and stroke regardless of low-density lipoprotein
Acknowledgments
This study was supported by grants from the Chang Gung Memorial Hospital Research Project (CMRPG881011) and the National Science Council Research Project (99-2314-B-182-055-MY2). We wish to thank Y.F. Chiang for her valuable technical assistance. Doctor Gene Alzona Nisperos provided language help and writing assistance for this manuscript.
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Contributed equally to this work.