ABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Lymphohistiocytosis, Hemophagocytic/etiology , Brain Diseases/complications , Lymphohistiocytosis, Hemophagocytic/diagnosis , Lymphohistiocytosis, Hemophagocytic/epidemiology , Brain Diseases/diagnosis , Splenomegaly/diagnostic imaging , Positron-Emission Tomography , Disease Progression , Diagnosis, DifferentialABSTRACT
INTRODUCCIÓN: La infección por el coronavirus SARS-CoV2 originada en diciembre de 2019 en la región china de Wuhan ha adquirido proporciones pandémicas. A día de hoy ha ocasionado de más de 1,7 millones de contagios y más de 100.000 muertes en todo el mundo. La investigación científica actual se centra en el mejor conocimiento de la infección aguda y de sus estrategias terapéuticas. Dada la magnitud de la epidemia, planteamos una revisión especulativa sobre las posibles consecuencias en patología neurológica a medio/largo plazo, con especial atención a Enfermedades neurodegenerativas y neuropsiquiátricas con base neuroinflamatoria, teniendo en cuenta la evidencia directa de afectación neurológica a causa de la infección aguda. DESARROLLO: Revisamos de forma sistemática lo conocido sobre los mecanismos patogénicos de la infección por SARS-Cov2, la repercusión de la tormenta de citoquinas sobre el Sistema Nervioso Central y su persistencia en el tiempo y las consecuencias que la neuroinflamación puede tener sobre el Sistema Nervioso Central. CONCLUSIONES: El SARS-CoV2 es un virus neuroinvasivo capaz de provocar una tormenta de citoquinas que podría convertirse en persistente en población seleccionada. Aunque nuestra hipótesis tiene alto componente especulativo, la repercusión que esta situación puede tener en la puesta en marcha y progresión de Enfermedades neurodegenerativas y neuropsiquiátricas con base neuroinflamatoria debe ser considerada como posible germen de una pandemia demorada que podría tener un gran impacto en salud pública a medio o largo plazo. Se hace necesario un estrecho seguimiento de la salud cognitiva y neuropsiquiátrica de los pacientes supervivientes a infección Covid19
INTRODUCTION: SARS-CoV-2 was first detected in December 2019 in the Chinese city of Wuhan and has since spread across the world. At present, the virus has infected over 1.7 million people and caused over 100000 deaths worldwide. Research is currently focused on understanding the acute infection and developing effective treatment strategies. In view of the magnitude of the epidemic, we conducted a speculative review of possible medium-and long-term neurological consequences of SARS-CoV-2 infection, with particular emphasis on neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin, based on the available evidence on neurological symptoms of acute SARS-CoV-2 infection. Development:We systematically reviewed the available evidence about the pathogenic mechanisms of SARS-CoV-2 infection, the immediate and lasting effects of the cytokine storm on the central nervous system, and the consequences of neuroinflammation for the central nervous system.Conclusions:SARS-CoV-2 is a neuroinvasive virus capable of triggering a cytokine storm, with persistent effects in specific populations. Although our hypothesis is highly speculative, the impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term. Cognitive and neuropsychological function should be closely monitored in COVID-19 survivors
Subject(s)
Humans , Coronavirus Infections/complications , Betacoronavirus/pathogenicity , Neurodegenerative Diseases/virology , Mental Disorders/virology , Cytokines/immunology , Cytokines/metabolism , Coronavirus Infections/immunology , Coronavirus Infections/metabolism , Acute Disease , Survivors , Follow-Up StudiesABSTRACT
INTRODUCCIÓN: La pandemia de Covid-19 va a conllevar cambios en la asistencia neurológica, que no se pueden prever fácilmente a largo plazo. MATERIAL Y MÉTODOS: A través de un modelo de informadores clave, se busca el consenso siendo los encuestados, jefes de servicio de Neurología con conocimiento amplio de la situación al haber actuado durante la pandemia, de cómo va a ser la especialidad en un plazo de cinco años. RESULTADOS: Aunque se obtiene un grado de acuerdo bajo entre encuestados, si se describen acuerdos por consenso a nivel mayor (85%) y menor (70%). Los principales acuerdos se refieren al incremento de precauciones, al uso de la telemedicina, al mantenimiento de las consultas telefónicas, a la reducción de asistencia a las consultas evitando que hayan salas de espera con un número alto de personas, al desarrollo de técnicas docentes no presenciales y a la adaptación en el desarrollo de ensayos clínicos en relación a la visita de los monitores. Sin embargo, no se acuerda que haya cambios en la indicación de exploraciones complementarias, ni en la propia exploración neurológica. CONCLUSIÓN: El método de informadores clave ha permitido conocer que cambios se pueden prever tras la pandemia
INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic
Subject(s)
Humans , Neurology/trends , Practice Management, Medical/trends , Patient Care Management/trends , Coronavirus Infections , Pneumonia, Viral , Betacoronavirus , Pandemics , Consensus Development Conferences as TopicABSTRACT
BACKGROUND: TMA-93 examines binding by images, a potential advantage for less-educated individuals. OBJECTIVE: To obtain norms from older Spanish adults for TMA-93. METHODS: A cross-sectional normative study was undertaken in a general neurology outpatient clinic of a university hospital in the Southern Spanish region of Andalusia. Partners of patients who attended the clinic were systematically recruited when eligible: aged 50 and over, no memory complaints, and a total score equal or above percentile 10 on Phototest. Age, gender, and educational attainment were considered as sociodemographic variables. TMA-93 was administered and the total score was registered. RESULTS: The final sample contained 1,131 participants (mean ageâ=â65.7, SDâ=â9.2), including 305 individuals (27%) who did not completed primary studies. The total score on TMA-93 showed a non-normal, left asymmetric, and leptokurtic distribution (medianâ=â29, interquartile rangeâ=â27-30, rangeâ=â16-30) mitigated by lower education and older age. Stratified analysis by age and education showed wide variations of the scores for the 5-percentile. CONCLUSION: TMA-93 runs with a ceiling effect in non-cognitively impaired older Spanish adults. The score for the 5-percentile depends on age and education. The test is feasible for low-educated individuals.
Subject(s)
Alzheimer Disease/diagnosis , Alzheimer Disease/psychology , Memory , Neuropsychological Tests/standards , Visual Perception , Aged , Cross-Sectional Studies , Educational Status , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: TMA-93 examines binding by images, an advantage for the less educated individuals. AIM: To compare the discriminative validity of TMA-93 against the picture version of Free and Cued Selective Reminding Test (FCSRT) to distinguish patients with amnestic mild cognitive impairment (aMCI) from normal controls (NCs) without excluding less educated individuals. DESIGN: Phase I diagnostic evaluation study. PARTICIPANTS: A total of 30 patients with aMCI and 30 NCs matched for sociodemographics variables. STATISTICAL ANALYSIS: The diagnostic accuracy for each test was calculated by conducting receiver operating characteristic curve analysis. Hanley and McNeil method was used to compare diagnostic accuracy of different tests on the same sample. RESULTS: Up to 41.7% of the sample had less than a first grade of education. Both tests showed excellent diagnostic accuracy. The comparisons did not show significant differences. CONCLUSIONS: TMA-93 is so accurate as FCSRT to differentiate aMCI from controls including less educated individuals. The test could be considered as a choice in this sociodemographic context.
Subject(s)
Amnesia/diagnosis , Cognitive Dysfunction/diagnosis , Neuropsychological Tests/standards , Aged , Aged, 80 and over , Case-Control Studies , Cross-Sectional Studies , Cues , Female , Humans , Male , Mental Recall/physiology , Reproducibility of ResultsABSTRACT
INTRODUCTION: There is still a scientific debate on the exact role played by obesity on stroke risk. OBJECTIVE: The aim of the study was to analyze the association between obesity, measured by different indices such as body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and a new one called A Body Shape Index (ABSI) and the risk of total and ischemic stroke. SUBJECTS/METHODS: A total of 41,020 subjects (15,490 men and 25,530 women) aged 29-69 years participated in the study. All participants were recruited between 1992 and 1996 and followed up until 2008 to ascertain incident cerebrovascular disease events. Cox proportional hazards models were designed to estimate the relative risk and 95% CI between obesity and cerebrovascular disease incidence. RESULTS: After 13.8 years of follow-up, a total of 674 stroke cases (55.3% in men) were registered (531 ischemic, 79 hemorrhagic, 42 subarachnoid hemorrhage and 22 unspecified). WC fourth quartile (HR 1.95; 95% CI 1.20-3.19) and WHR fourth quartile (HR 1.58; 95% CI 1.12-2.25) were positively associated with total stroke only in men. BMI was not associated with stroke incidence. The new index, ABSI, was significantly associated with total stroke incidence only in men (HR 1.54; 95% CI 1.06-2.23). CONCLUSIONS: Data from the Spanish EPIC cohort study show a strong association of WC and WHR with the relative risk of suffering a stroke only in men, while no associations were found for BMI. It supports the suggestion of other authors of using more than one obesity index in the study of stroke risk prediction.
Subject(s)
Obesity/epidemiology , Stroke/epidemiology , Adult , Aged , Body Mass Index , Energy Intake , Female , Follow-Up Studies , Humans , Incidence , Life Style , Male , Middle Aged , Motor Activity , Nutrition Surveys , Proportional Hazards Models , Prospective Studies , Risk Factors , Spain , Waist Circumference , Waist-Hip Ratio , White PeopleABSTRACT
Introducción y objetivos. Conocer en nuestro medio la eficacia, tolerabilidad y satisfacción del paciente migrañoso con diferentes triptanes en función de las características de sus crisis e intentar establecer un modelo predictivo para recomendar uno u otro en función de dichas características. Pacientes y métodos. Estudio retrospectivo observacional multicéntrico en unidades de cefalea. Se incluyen pacientes con migraña que utilizan un mismo triptán para el tratamiento de sus crisis. Se analizan datos de preferencia, eficacia, rapidez y tolerancia. Resultados. Se analizan 160 pacientes (88 mujeres), con una edad media de 42,92 años. Los triptanes más utilizados fueron eletriptán, almotriptán y rizatriptán. Tanto pacientes como médicos mostraron un alto grado de satisfacción (88% y 65%, respectivamente) con el triptán utilizado. En las encuestas de preferencia, los pacientes preferían el triptán actual sobre el previo (83%) o fármacos no específicos (93%). La valoración global en una escala analógica visual estuvo por encima de 7 para todos los triptanes, sin diferencias entre ellos. Al analizar la utilización de un determinado triptán en función de las características de las crisis, no se encontraron diferencias estadísticamente significativas. Conclusiones. En este grupo seleccionado de pacientes, los triptanes son un tratamiento por el que los pacientes muestran un alto grado de satisfacción. Aunque no existen diferencias globales en las puntuaciones entre los diferentes triptanes, el hecho de que determinados triptanes sean más utilizados por los pacientes después de experiencias previas con otros sugiere una mayor eficacia por su parte. No hemos encontrado ningún parámetro que prediga la utilización de un determinado triptán(AU)
Introduction and aims. This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. Patients and methods. Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. Results. The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. Conclusions. In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan(AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Migraine Disorders/diagnosis , Migraine Disorders/therapy , Patient Satisfaction , Treatment Outcome , Evaluation of the Efficacy-Effectiveness of Interventions , Retrospective Studies , Cross-Sectional Studies/methods , Cross-Sectional Studies/trends , Cross-Sectional Studies , Surveys and QuestionnairesABSTRACT
Arterial hypertension (AHT) and cognitive problems, especially dementia, are very prevalent among the elderly. AHT is a direct risk factor for vascular dementia and recent studies have shown that it also has repercussions on the prevalence of Alzheimer's disease. Thus, given the fact that there is currently no effective treatment, the prevention of dementia with the aim of delaying or even preventing its appearance is a priority. Moreover, it leads us to pose the question as to whether treating AHT can help prevent dementia. To answer this question, we present a review of the main studies involving interventions with antihypertensive drugs in the prevention of dementia that have been published to date. These trials and meta-analyses suggest that antihypertensive treatment could reduce the risk of dementia by 3-20%, although with no clear statistical significance. However, there are a number of methodological limitations that largely account for the lack of conclusive results in the different intervention studies and which make it possible to deduce that the treatment of AHT does clearly reduce the appearance of dementia. Therefore, clearly further studies on hypertension need to be conducted with the primary aim of appraising the appearance of cognitive impairment or dementia.
Subject(s)
Antihypertensive Agents/therapeutic use , Dementia, Vascular/etiology , Dementia, Vascular/prevention & control , Hypertension/complications , Hypertension/drug therapy , Clinical Trials as Topic , HumansABSTRACT
La hipertensión arterial (HTA) y los problemas cognitivos, en particular la demencia, son muy prevalentes en las personas mayores. La HTA es un factor de riesgo directo de demencia vascular, y estudios recientes han señalado que también repercute sobre la prevalencia de la enfermedad de Alzheimer. Entonces, dado que en la actualidad se carece de tratamientos efectivos, la prevención de la demencia con el objetivo de retrasar o incluso evitar su aparición es prioritaria y, además, hace que nos planteemos la cuestión de si tratar la HTA puede ayudar a prevenir la demencia. Para responder a esta cuestión, se presenta una revisión de los principales trabajos de intervención con fármacos antihipertensivos en la prevención de demencia publicados hasta la fecha. Estos ensayos y metaanálisis sugieren que el tratamiento antihipertensivo podría reducir el riesgo de demencia un 3-20%, aunque sin clara significación estadística. No obstante, existen numerosas limitaciones metodológicas que justifican en gran parte la falta de resultados concluyentes en los diferentes estudios de intervención y que permitan inferir que el tratamiento de la HTA reduce de forma evidente la aparición de demencia. Por tanto, se necesita claramente la realización de nuevos estudios en hipertensión cuyo objetivo primario sea valorar la aparición de deterioro cognitivo o demencia (AU)
Arterial hypertension (AHT) and cognitive problems, especially dementia, are very prevalent among the elderly. AHT is a direct risk factor for vascular dementia and recent studies have shown that it also has repercussions on the prevalence of Alzheimers disease. Thus, given the fact that there is currently no effective treatment, the prevention of dementia with the aim of delaying or even preventing its appearance is a priority. Moreover, it leads us to pose the question as to whether treating AHT can help prevent dementia. To answer this question, we present a review of the main studies involving interventions with antihypertensive drugs in the prevention of dementia that have been published to date. These trials and meta-analyses suggest that antihypertensive treatment could reduce the risk of dementia by 3-20%, although with no clear statistical significance. However, there are a number of methodological limitations that largely account for the lack of conclusive results in the different intervention studies and which make it possible to deduce that the treatment of AHT does clearly reduce the appearance of dementia. Therefore, clearly further studies on hypertension need to be conducted with the primary aim of appraising the appearance of cognitive impairment or dementia (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Hypertension/prevention & control , Hypertension/therapy , Dementia/prevention & control , Risk Factors , Alzheimer Disease/epidemiology , Alzheimer Disease/prevention & control , Antihypertensive Agents/therapeutic use , Cohort Studies , Cognitive Dissonance , Indicators of Morbidity and Mortality , Cardiovascular Diseases/drug therapy , Cardiovascular Diseases/prevention & controlABSTRACT
En los últimos tres años se ha logrado en Andalucía, España, un avance significativo en las medidas de actuación en el ataque cerebral agudo. Este avance está relacionado en primer lugar con una mayor participación y compromiso de los profesionales de la salud en sus diferentes áreas para dar respuesta coordinada al ataque cerebral. El PLACA es un plan autonómico que se viene desarrollando desde hace cinco años en Andalucía, contribuyendo así a esta respuesta unitaria con su planificación. Colabora un grupo central formado por expertos de distintas sociedades científicas, coordinados por el Plan Andaluz de Salud y dependiente de la Dirección General del Servicio Andaluz de Salud. En este artículo se presentan los avances conseguidos en los últimos tres años con este plan, así como los objetivos futuros. Actualmente se ha logrado implementar la terapia trombolítica hasta en 55% de los hospitales de la comunidad, con una previsión del 100% para 2010. El incremento del número de trombólisis en los dos últimos años ha sido de más del doble respecto del período anterior. Se expone el importante esfuerzo económico realizado en la divulgación, información de medidas preventivas, formación de profesionales y desarrollo de telemedicina. No obstante, se considera necesario seguir avanzando. Las importantes medidas previstas para los próximos años ayudarán a continuar esta lucha, tratando de dar una respuesta más operativa y rápida, prevenir, y tratar de detener este incremento esperado de incidencia en la población, al mismo tiempo que se analizan mejor los resultados de la actitud terapeútica realizada.(AU)
Subject(s)
Stroke/prevention & control , Stroke/therapy , Thrombolytic Therapy/instrumentation , Thrombolytic Therapy/statistics & numerical data , Health Programs and Plans/organization & administration , SpainABSTRACT
En los últimos tres años se ha logrado en Andalucía, España, un avance significativo en las medidas de actuación en el ataque cerebral agudo. Este avance está relacionado en primer lugar con una mayor participación y compromiso de los profesionales de la salud en sus diferentes áreas para dar respuesta coordinada al ataque cerebral. El PLACA es un plan autonómico que se viene desarrollando desde hace cinco años en Andalucía, contribuyendo así a esta respuesta unitaria con su planificación. Colabora un grupo central formado por expertos de distintas sociedades científicas, coordinados por el Plan Andaluz de Salud y dependiente de la Dirección General del Servicio Andaluz de Salud. En este artículo se presentan los avances conseguidos en los últimos tres años con este plan, así como los objetivos futuros. Actualmente se ha logrado implementar la terapia trombolítica hasta en 55% de los hospitales de la comunidad, con una previsión del 100% para 2010. El incremento del número de trombólisis en los dos últimos años ha sido de más del doble respecto del período anterior. Se expone el importante esfuerzo económico realizado en la divulgación, información de medidas preventivas, formación de profesionales y desarrollo de telemedicina. No obstante, se considera necesario seguir avanzando. Las importantes medidas previstas para los próximos años ayudarán a continuar esta lucha, tratando de dar una respuesta más operativa y rápida, prevenir, y tratar de detener este incremento esperado de incidencia en la población, al mismo tiempo que se analizan mejor los resultados de la actitud terapeútica realizada.
Subject(s)
Stroke/prevention & control , Stroke/therapy , Health Programs and Plans/organization & administration , Thrombolytic Therapy/instrumentation , Thrombolytic Therapy , SpainSubject(s)
Anticholesteremic Agents/therapeutic use , Carotid Stenosis/drug therapy , Coronary Artery Disease/drug therapy , Heptanoic Acids/therapeutic use , Ischemic Attack, Transient/drug therapy , Pyrroles/therapeutic use , Stroke/drug therapy , Age Distribution , Age Factors , Aged , Atorvastatin , Carotid Stenosis/epidemiology , Carotid Stenosis/prevention & control , Clinical Trials as Topic/statistics & numerical data , Comorbidity , Coronary Artery Disease/epidemiology , Coronary Artery Disease/prevention & control , Humans , Ischemic Attack, Transient/epidemiology , Ischemic Attack, Transient/prevention & control , Outcome Assessment, Health Care/methods , Stroke/epidemiology , Stroke/prevention & control , Treatment OutcomeSubject(s)
Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Hypertension/drug therapy , Renin-Angiotensin System/drug effects , Stroke/prevention & control , Blood Pressure/physiology , Humans , Hypertension/complications , Hypertension/physiopathology , Multicenter Studies as Topic , Stroke/physiopathologyABSTRACT
Introducción. La utilización de las estatinas en la enfermedad cerebrovascular es hoy día un campo en expansión. Los resultados que numerosos ensayos clínicos con estatinas han proporcionado hacen que se estén revisando conceptos tradicionales en el tratamiento de la enfermedad cerebrovascular. Objetivo. Realizar una revisión actualizada del papel de las estatinas en el ictus, en la que se analicen de manera pormenorizada los diferentes ensayos en prevención primaria y secundaria de la enfermedad cerebrovascular. Método. Revisión bibliográfica de los artículos publicados en PubMed sobre estatinas e ictus. Resultados. En la actualidad hay más de 1.300artículos sobre estatinas e ictus en PubMed, de los cuales más de 500 son revisiones. Es de reseñar que en el último metaanálisis sobre estatinas e ictus, el CTT (Cholesterol Treatment Trials Collaborators),que incluye a más de 90.000 pacientes, se demuestra que las estatinas disminuyen la incidencia de ictus, con una reducción de riesgo relativo del 21%, y que este efecto se debe fundamentalmente al grado de reducción del colesterol unido a lipoproteínas de baja densidad. Conclusiones. Actualmente las estatinas están indicadas para prevenir la aparición y la recurrencia del ictus isquémico, y, recientemente, nuevos datos indican su utilidad en la fase aguda del ictus, incluso como tratamiento coadyuvante en la fibrinólisis o la angioplastia (AU)
Introduction. The use of statins incerebrovascular disease is currently a rapidly expanding field. The results of numerous clinical studies with statins have lead to traditional concepts in the management of cerebrovascular disease being reviewed. Objective. To perform an up-to-date review on the role of statins in stroke, and to carry out a detailed analysis of the different studies on the primary and secondary prevention of cerebrovascular disease. Method. A literature review of articles published in PubMed on statins and stroke (estatinas y ictus).Results. There are currently more than 1300articles published on statins and stroke in PubMed, of which more than 500 are reviews. It is worth noting that in the latest meta-analysis on statins and stroke, the CTT (Cholesterol Treatment Trials Collaborators), which includes more than 90,000patients, it shows that statins reduce the incidence of stroke, with a relative risk reduction (RRR) of21%, and that this effect is basically due to level of reduction of low density lipoprotein cholesterol(LDL-cholesterol).Conclusions. Statins are currently indicated for the prevention and recurrence of is chaemic stroke, and, recently, new data suggests that it is useful in the acute phase of stroke, as well as a coadjuvant therapy in fibrinolys is or angioplasty (AU)
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Stroke/congenital , Stroke/complications , Stroke/diagnosis , Stroke/epidemiology , Stroke/therapyABSTRACT
Historically, the etiological link between hypercholesterolemia and stroke has been less clear than for coronary heart disease. The lack of association between cholesterol levels and stroke in most epidemiological and observational studies has brought about this controversy. Many recent, long-term clinical studies have confirmed that statin therapy results in a reduced risk of strokes, even in so-called "normocholesterolemic" patients. The magnitude of the effect is great. A large-scale analysis of more than 90,000 individuals showed that every 10% reduction in the concentration of LDL-cholesterol reduces the risk of stroke by 15.6%. The positive effect of statins on stroke depends mainly on LDL cholesterol reduction, but other non-lipid mechanisms, so-called "pleiotropic" effects, have been shown to play a role. This review seeks to summarize the role of statins in stroke prevention. Despite the fact that our understanding of the benefits of statins in stroke prevention is still evolving, we find marked room for improvement in stroke risk factor management. Internists must face this challenge and integrate this new knowledge into their daily clinical practice.
Subject(s)
Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Stroke/prevention & control , Animals , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/pharmacology , Hyperlipidemias/complications , Hyperlipidemias/drug therapy , Practice Guidelines as Topic , Stroke/complicationsABSTRACT
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