Effectiveness of statins on outcomes of patients with Embolic Stroke of Undetermined Source (ESUS).

BACKGROUND: Statins are highly recommended as a secondary prevention strategy after a stroke. Embolic Stroke of Undetermined Source (ESUS) accounts for up to one fifth of cases of ischemic stroke. There is a lack of studies investigating the effectiveness of statins in this subgroup of patients. METHODS: We designed a longitudinal cohort study involving patients properly diagnosed with ESUS. Data about statin therapy included information about the time of initiation of the treatment, pre-stroke statin use, statin withdrawal, and the type and dosage of the statin prescribed. Patients were followed for 48 months after the index stroke. The primary endpoints included stroke recurrence, major cardiovascular events, and death from all causes. The secondary endpoint was the functional outcome, assessed in a standardized and systematic way using the modified Rankin Scale (mRS). RESULTS: Patients who were not taking any statin after ESUS have significantly increased odds of stroke recurrence (OR = 3.29, 95% CI 1.27 - 8.55) or presenting the composite outcome of stroke recurrence, major cardiovascular events, and death (OR = 3.70, 95% CI 1.44 - 9.50) in the multivariate analysis. No statin therapy was directly associated with the functional outcome as well (OR = 3.32, 95% CI = 1.58 - 6.96). The early initiation of the statin therapy was estimated to reduce the risk of a second stroke and the composite outcome by 89% and 87%. CONCLUSIONS: Our pioneering study provides evidence that patients with ESUS may benefit from statin therapy, especially if prescribed early and at higher dosages.

Ischemic stroke with unknown onset of symptoms: current scenario and perspectives for the future.

BACKGROUND: Stroke is a major cause of disability worldwide and a neurological emergency. Intravenous thrombolysis and mechanical thrombectomy are effective in the reperfusion of the parenchyma in distress, but the impossibility to determine the exact time of onset was an important cause of exclusion from treatment until a few years ago. OBJECTIVES: To review the clinical and radiological profile of patients with unknown-onset stroke, the imaging methods to guide the reperfusion treatment, and suggest a protocol for the therapeutic approach. METHODS: The different imaging methods were grouped according to current evidence-based treatments. RESULTS: Most studies found no difference between the clinical and imaging characteristics of patients with wake-up stroke and known-onset stroke, suggesting that the ictus, in the first group, occurs just prior to awakening. Regarding the treatment of patients with unknown-onset stroke, four main phase-three trials stand out: WAKE-UP and EXTEND for intravenous thrombolysis, and DAWN and DEFUSE-3 for mechanical thrombectomy. The length of the therapeutic window is based on the diffusion weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch, core-penumbra mismatch, and clinical core mismatch paradigms. The challenges to approach unknown-onset stroke involve extending the length of the time window, the reproducibility of real-world imaging modalities, and the discovery of new methods and therapies for this condition. CONCLUSION: The advance in the possibilities for the treatment of ischemic stroke, while guided by imaging concepts, has become evident. New studies in this field are essential and needed to structure the health care services for this new scenario.

ANTECEDENTES: O acidente vascular cerebral (AVC) é uma das principais causas de incapacidade em todo o mundo, e uma emergência neurológica. A trombólise intravenosa e a trombectomia mecânica são eficazes na reperfusão do parênquima em sofrimento, mas a impossibilidade de determinar o tempo exato de início era uma causa importante de exclusão ao tratamento até alguns anos atrás. OBJETIVOS: Revisar o perfil clínico-radiológico dos pacientes com AVC de tempo indeterminado, os métodos de imagem para guiar o tratamento de reperfusão, e sugerir um protocolo para a abordagem terapêutica. MéTODOS: Os diferentes métodos de imagem foram agrupados de acordo com os tratamentos atuais baseados em evidências. RESULTADOS: A maioria dos estudos não encontrou diferença entre as características clínicas e de imagem dos pacientes com AVC reconhecido ao despertar e AVC de tempo definido, o que sugere que o icto, no primeiro grupo, ocorre próximo ao acordar. Quanto ao tratamento do AVC de tempo indeterminado, quatro grandes estudos na fase três sobressaem: WAKE-UP e EXTEND para trombólise intravenosa, e DAWN e DEFUSE-3 para trombectomia mecânica. A ampliação da janela terapêutica fundamenta-se nos paradigmas de incompatibilidade da imagem ponderada de difusão­recuperação da inversão atenuada por fluidos (diffusion weighted imaging­fluid-attenuated inversion recovery, DWI-FLAIR, em inglês), do núcleo isquêmico e penumbra, e clínico-radiológico. Os desafios na abordagem do AVC de tempo indeterminado envolvem a ampliação da janela terapêutica, a reprodutibilidade das modalidades de imagem no mundo real, e a identificação de novos métodos e tratamentos para essa condição. CONCLUSãO: É evidente o avanço nas possibilidades de tratamento do AVC isquêmico guiado pelos conceitos de imagem. Novos estudos nesse campo são essenciais, com necessidade de estruturar os serviços de saúde para esse novo cenário.

Ischemic stroke with unknown onset of symptoms: current scenario and perspectives for the future / Acidente vascular cerebral isquêmico com tempo indeterminado de início dos sintomas: cenário atual e perspectivas para o futuro

Abstract Background Stroke is a major cause of disability worldwide and a neurological emergency. Intravenous thrombolysis and mechanical thrombectomy are effective in the reperfusion of the parenchyma in distress, but the impossibility to determine the exact time of onset was an important cause of exclusion from treatment until a few years ago. Objectives To review the clinical and radiological profile of patients with unknown-onset stroke, the imaging methods to guide the reperfusion treatment, and suggest a protocol for the therapeutic approach. Methods The different imaging methods were grouped according to current evidence-based treatments. Results Most studies found no difference between the clinical and imaging characteristics of patients with wake-up stroke and known-onset stroke, suggesting that the ictus, in the first group, occurs just prior to awakening. Regarding the treatment of patients with unknown-onset stroke, four main phase-three trials stand out: WAKE-UP and EXTEND for intravenous thrombolysis, and DAWN and DEFUSE-3 for mechanical thrombectomy. The length of the therapeutic window is based on the diffusion weighted imaging-fluid-attenuated inversion recovery (DWI-FLAIR) mismatch, core-penumbra mismatch, and clinical core mismatch paradigms. The challenges to approach unknown-onset stroke involve extending the length of the time window, the reproducibility of real-world imaging modalities, and the discovery of new methods and therapies for this condition. Conclusion The advance in the possibilities for the treatment of ischemic stroke, while guided by imaging concepts, has become evident. New studies in this field are essential and needed to structure the health care services for this new scenario.

Resumo Antecedentes O acidente vascular cerebral (AVC) é uma das principais causas de incapacidade em todo o mundo, e uma emergência neurológica. A trombólise intravenosa e a trombectomia mecânica são eficazes na reperfusão do parênquima em sofrimento, mas a impossibilidade de determinar o tempo exato de início era uma causa importante de exclusão ao tratamento até alguns anos atrás. Objetivos Revisar o perfil clínico-radiológico dos pacientes com AVC de tempo indeterminado, os métodos de imagem para guiar o tratamento de reperfusão, e sugerir um protocolo para a abordagem terapêutica. Métodos Os diferentes métodos de imagem foram agrupados de acordo com os tratamentos atuais baseados em evidências. Resultados A maioria dos estudos não encontrou diferença entre as características clínicas e de imagem dos pacientes com AVC reconhecido ao despertar e AVC de tempo definido, o que sugere que o icto, no primeiro grupo, ocorre próximo ao acordar. Quanto ao tratamento do AVC de tempo indeterminado, quatro grandes estudos na fase três sobressaem: WAKE-UP e EXTEND para trombólise intravenosa, e DAWN e DEFUSE-3 para trombectomia mecânica. A ampliação da janela terapêutica fundamenta-se nos paradigmas de incompatibilidade da imagem ponderada de difusão-recuperação da inversão atenuada por fluidos (diffusion weighted imaging-fluid-attenuated inversion recovery, DWI-FLAIR, em inglês), do núcleo isquêmico e penumbra, e clínico-radiológico. Os desafios na abordagem do AVC de tempo indeterminado envolvem a ampliação da janela terapêutica, a reprodutibilidade das modalidades de imagem no mundo real, e a identificação de novos métodos e tratamentos para essa condição. Conclusão É evidente o avanço nas possibilidades de tratamento do AVC isquêmico guiado pelos conceitos de imagem. Novos estudos nesse campo são essenciais, com necessidade de estruturar os serviços de saúde para esse novo cenário.

The prognostic significance of the lipid profile after an ischemic stroke.

BACKGROUND: The role that cholesterol levels play in stroke is still uncertain, especially in secondary prevention. The aim was to determine how a comprehensive analysis of the lipid profile can be associated with post-stroke outcomes.Consecutive patients diagnosed with ischemic stroke were included in our cohort and followed up for 24months. Baseline clinical and demographic data were collected as well as a complete lipid profile 6-months after the index stroke. Lipid variables were analyzed quantitatively and qualitatively. Clinical outcomes included stroke recurrence, major cardiovascular events, and functional performance (assessed with the modified Rankin scale). RESULTS: The study included 588 patients with an average age of 58.3 years. There were 148 (25.2%) patients with high total cholesterol, 260 (44.2%) with low HDL, 180 (30.6%) with high LDL, and 204 (34.7%) with high triglycerides. There were 164 (27.9%) patients with no abnormalities in the lipid profile. After the follow-up, 108 (18.3%) had another stroke, 32 (5.4%) had major cardiovascular events, and 360 (61.2%) presented good functional outcomes. A higher LDL-C/HDL-C ratio and a low HDL-C level were significantly associated with worse cardiovascular outcomes. The detection of LDL-C > 70 mg/dL was an independent predictor of a higher risk of stroke recurrence and worse functional performance. The greater the number of altered lipid variables, the greater the chance of developing an unfavorable composite outcome and presenting cardiovascular events after the stroke. CONCLUSIONS: The complete analysis of the lipid panel allows the determination of the prognosis of patients who suffered a stroke.

Effectiveness of statins in patients with stroke due to cervical artery dissection: A preliminary study / Efectividad de las estatinas en pacientes con ictus debido a disección arterial cervical: un estudio preliminar

Background: Statin therapy has become one of the most important advances in stroke secondary prevention. Nevertheless, statin therapy in patients who present an ischemic stroke following cervical artery dissection (CAD) has not yet been supported by clinical evidence. This study aimed to investigate the effect of statins on neurological outcomes after a stroke due to CAD.MethodsWe conducted a prospective cohort study including consecutive patients diagnosed with a stroke due to CAD. Subjects were classified into non-statin, simvastatin 20mg, simvastatin 40mg, and high-potency statin groups. After 2 years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed.ResultsAmong the 54 patients included in our cohort, there were 16 (29.6%) patients without statins, 22 (40.7%) with simvastatin 20mg, 12 (22.2%) with simvastatin 40mg and 4 (7.5%) with high-potency statins. Using simvastatin 40mg was associated with a significantly lower incidence of stroke recurrence. Patients with simvastatin 40mg and high-potency statins presented the best functional recovery throughout the follow-up (p<.01).DiscussionThe use of statins in patients with CAD-related stroke may improve functional outcomes in specific cases. Statins do not prevent stroke recurrence and major cardiovascular events in this type of stroke. (AU)

Introducción: La terapia con estatinas se ha convertido en uno de los avances más importantes en la prevención secundaria del ictus. Sin embargo, la terapia con estatinas en pacientes que presentan un ictus isquémico después de la disección arterial cervical (CAD) aún no ha sido respaldada por evidencia clínica. Este estudio tuvo como objetivo investigar el efecto de las estatinas en los resultados neurológicos después de un ictus debido a CAD.MétodosRealizamos un estudio de cohorte prospectivo que incluyó pacientes consecutivos diagnosticados con un ictus debido a CAD. Los sujetos se clasificaron en: sin estatina, simvastatina 20mg, simvastatina 40mg y grupos de estatina de alta potencia. Después de 2 años se evaluaron el resultado funcional, la recurrencia del ictus, los principales eventos cardiovasculares y la mortalidad.ResultadosEntre los 54 pacientes incluidos en nuestra cohorte había 16 (29,6%) pacientes sin estatinas, 22 (40,7%) con simvastatina 20mg, 12 (22,2%) con simvastatina 40mg y 4 (7,5%) con estatinas de alta potencia. El uso de simvastatina 40mg se asoció con una incidencia significativamente menor de recurrencia de accidente cerebrovascular menor. Los pacientes con simvastatina 40mg y estatinas de alta potencia presentaron la mejor recuperación funcional durante todo el seguimiento (p<0,01).DiscusiónEl uso de estatinas en pacientes con ictus relacionado con CAD puede mejorar los resultados funcionales en casos específicos. Las estatinas no previenen la recurrencia del ictus y los principales eventos cardiovasculares en este tipo de ictus. (AU)

Misoplegia and dementia: a case study.

Brain-damaged patients can develop abnormal attitudes towards their deficits. Misoplegia is one such example, involving exaggerated aversion to an impaired limb, sometimes associated with hatred of paresis and verbal or physical abuse directed at the paretic limb. Few studies or reports on this disorder are available in the literature, prompting the present case report of a patient with misoplegia and vascular dementia.

Pacientes com lesões cerebrais podem apresentar atitudes anormais em relação a seus déficits. Um exemplo é a misoplegia, uma aversão excessiva em relação ao membro com déficit, podendo estar associado a ódio à paralisia e maus tratos verbais ou físicos contra os membros paralisados. Ainda há poucos estudos e relatos sobre esse distúrbio na literatura, evidenciando a importância de um relato de caso de um paciente portador de misoplegia e demência vascular.

Prevalence and Predictors of Fatigue and Neuropsychiatric Symptoms in Patients with Minor Ischemic Stroke.

OBJECTIVES: Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke. MATERIALS AND METHODS: We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS < 4 and modified Rankin Scale (mRS) < 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively. RESULTS: A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p < 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders. CONCLUSIONS: Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.

Post-stroke aphasia in famous writers: when Neurology left geniuses speechless.

Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.

Popular knowledge of stroke in São Paulo: a cross-sectional study within the World Stroke Campaign

ABSTRACT BACKGROUND: Stroke is the second leading cause of death in Brazil and the main cause of disability. Inability to identify alarm signals causes delays in seeking emergency services, thereby leading to a worse prognosis. OBJECTIVES: To assess the population's knowledge of how to recognize and prevent stroke. DESIGN AND SETTING: Prospective cross-sectional study on data derived from a questionnaire that was administered during the 2016 World Stroke Campaign, launched in the city of São Paulo, Brazil. METHODS: Data on 806 interviewees were evaluated using descriptive statistics and univariate and multivariate analyses. RESULTS: Among all the interviewees, 52.1% knew how to conceptualize stroke; 70.07% knew someone who had suffered a stroke; and 29.03% listed three or more risk factors. Only 27.5% mentioned controlling high blood pressure as a preventive measure. In the event of witnessing a stroke, 57.8% would call the emergency service and 2.9% would check the timing. Less educated individuals were 5.6 times more likely (95% confidence interval, CI 3.45-9.02) to have poor knowledge of stroke, compared with the more educated group. Knowing someone who had had a stroke reduced the chances of not knowing the terms relating to the disease (odds ratio, OR = 0.56; 95% CI 0.4-0.78). CONCLUSIONS: Despite the severity and prevalence of stroke, the population still has little information on this disease. In this context, the importance of mounting campaigns to improve prevention and treatment and to contribute to healthcare policies becomes evident.

Misoplegia and dementia: a case study / Misoplegia e demência: relato de caso

ABSTRACT. Brain-damaged patients can develop abnormal attitudes towards their deficits. Misoplegia is one such example, involving exaggerated aversion to an impaired limb, sometimes associated with hatred of paresis and verbal or physical abuse directed at the paretic limb. Few studies or reports on this disorder are available in the literature, prompting the present case report of a patient with misoplegia and vascular dementia.

RESUMO. Pacientes com lesões cerebrais podem apresentar atitudes anormais em relação a seus déficits. Um exemplo é a misoplegia, uma aversão excessiva em relação ao membro com déficit, podendo estar associado a ódio à paralisia e maus tratos verbais ou físicos contra os membros paralisados. Ainda há poucos estudos e relatos sobre esse distúrbio na literatura, evidenciando a importância de um relato de caso de um paciente portador de misoplegia e demência vascular.

Popular knowledge of stroke in São Paulo: a cross-sectional study within the World Stroke Campaign.

BACKGROUND: Stroke is the second leading cause of death in Brazil and the main cause of disability. Inability to identify alarm signals causes delays in seeking emergency services, thereby leading to a worse prognosis. OBJECTIVES: To assess the population's knowledge of how to recognize and prevent stroke. DESIGN AND SETTING: Prospective cross-sectional study on data derived from a questionnaire that was administered during the 2016 World Stroke Campaign, launched in the city of São Paulo, Brazil. METHODS: Data on 806 interviewees were evaluated using descriptive statistics and univariate and multivariate analyses. RESULTS: Among all the interviewees, 52.1% knew how to conceptualize stroke; 70.07% knew someone who had suffered a stroke; and 29.03% listed three or more risk factors. Only 27.5% mentioned controlling high blood pressure as a preventive measure. In the event of witnessing a stroke, 57.8% would call the emergency service and 2.9% would check the timing. Less educated individuals were 5.6 times more likely (95% confidence interval, CI 3.45-9.02) to have poor knowledge of stroke, compared with the more educated group. Knowing someone who had had a stroke reduced the chances of not knowing the terms relating to the disease (odds ratio, OR = 0.56; 95% CI 0.4-0.78). CONCLUSIONS: Despite the severity and prevalence of stroke, the population still has little information on this disease. In this context, the importance of mounting campaigns to improve prevention and treatment and to contribute to healthcare policies becomes evident.

Post-stroke aphasia in famous writers: when Neurology left geniuses speechless / Afasia pós-AVC em escritores famosos: quando a Neurologia deixou gênios sem palavras

ABSTRACT Aphasia is a frequent and devastating stroke complication that does not spare even great writers. In these cases, not only one of the highest cognitive functions is suddenly lost but also the act of bringing beauty into the world. Herein, we discuss the case of three writers who had to abandon their art compulsorily due to a cerebrovascular disease: Charles Baudelaire, Ralph Waldo Emerson, and Stendhal. They were magnificent writers, united by excellence in literature and an inevitable destiny that restricted their art to just a few words. They are also examples of the proximity of Neurology to Art, History, and Literature.

RESUMO A afasia é uma complicação frequente e devastadora do acidente vascular cerebral (AVC), que não poupa nem mesmo os grandes escritores. Nesses casos, de repente, perde-se não apenas uma das funções cognitivas mais importantes, mas o ato de colocar a beleza no mundo. Discutimos o caso de três escritores que precisaram abandonar sua arte compulsoriamente devido a uma doença cerebrovascular: Charles Baudelaire, Ralph Waldo Emerson e Stendhal. Todos eles foram escritores magníficos, unidos pela excelência em literatura e por um destino inevitável que restringia sua arte a apenas algumas palavras. Eles também são exemplos da proximidade da Neurologia com a Arte, a História e a Literatura.

Effect of speech therapy intervention program for non-fluent aphasic patients after stroke.

PURPOSE: the objective of this paper is to verify the effect of speech therapy intervention program in patients with non-fluent aphasia due to stroke in language tasks related to verbal fluency in semantic and phonological categories. METHODS: Patients with aphasia due to stroke were selected to take part in this study. Two groups were formed: diagnosed patients with Broca/transcortical motor aphasia (GA), and a control group (healthy individuals). GA took a fluency verbal task (FAS, other complementary categories: phonological /p/ /l/ and semantic: "fruits" and "names"). These patients were all engaged in a language intervention program developed by the authors of this study. GA received speech therapy sessions (ten sessions lasting for an hour once a week), following a specific language program. After the sessions, the patients were re-evaluated. RESULTS: GA had statistical significant improvement in the verbal fluency task after the speech therapy program (p-value < 0,001). CONCLUSION: The speech language therapy program we proposed was efficient enough to show improvement in the results for GA in the verbal fluency task.

The influence of statin withdrawal and adherence on stroke outcomes.

INTRODUCTION: With multiple proven benefits, statin therapy has become the most critical advance in stroke prevention. We aimed to evaluate the risk factors and the effect of poor adherence or statin interruption on the clinical outcomes of ischemic stroke. METHODS: This prospective cohort study included patients admitted with acute ischemic stroke between 2014 and 2018. Consecutive patients were distinguished into subgroups according to the adherence and withdrawal of statin. All participants were followed for 24 months. The outcomes included stroke recurrence, major cardiovascular events, all-cause mortality, and functional performance. Functional outcome was assessed using the modified Rankin Scale at 7 days, 30 days, 6 months, and 2 years after hospital admission for ischemic stroke. In a secondary analysis, outcome variables were compared with statin-naïve patients. RESULTS: We included 479 patients with acute ischemic stroke. The mean age was 58.3, and 55.0% were male. There were 96 (21.8%) patients who received no statin, 150 (34.9%) patients with poor adherence, 40 (9.1%) patients with intermediate adherence, and 154 (35.0%) patients with good adherence. There were 54 (15.7%) cases of withdrawal of treatment. Patients with hypertension, previous stroke, and large-artery atherosclerosis were associated with poor adherence (p < 0.05). Those with poor adherence were significantly associated with worse functional outcomes and a higher incidence of stroke recurrence (p < 0.05). Significant functional recovery was just seen in patients with satisfactory adherence. CONCLUSION: The suboptimal use of statins is associated with significantly worse clinical outcomes in stroke patients.

Effectiveness of statins in patients with stroke due to cervical artery dissection: A preliminary study.

BACKGROUND: Statin therapy has become one of the most important advances in stroke secondary prevention. Nevertheless, statin therapy in patients who present an ischemic stroke following cervical artery dissection (CAD) has not yet been supported by clinical evidence. This study aimed to investigate the effect of statins on neurological outcomes after a stroke due to CAD. METHODS: We conducted a prospective cohort study including consecutive patients diagnosed with a stroke due to CAD. Subjects were classified into non-statin, simvastatin 20mg, simvastatin 40mg, and high-potency statin groups. After 2 years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS: Among the 54 patients included in our cohort, there were 16 (29.6%) patients without statins, 22 (40.7%) with simvastatin 20mg, 12 (22.2%) with simvastatin 40mg and 4 (7.5%) with high-potency statins. Using simvastatin 40mg was associated with a significantly lower incidence of stroke recurrence. Patients with simvastatin 40mg and high-potency statins presented the best functional recovery throughout the follow-up (p<.01). DISCUSSION: The use of statins in patients with CAD-related stroke may improve functional outcomes in specific cases. Statins do not prevent stroke recurrence and major cardiovascular events in this type of stroke.

Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil / Efeitos da terapia com estatinas nos desfechos do acidente vascular cerebral isquêmico: uma experiência de mundo real no Brasil

ABSTRACT Background: Statin therapy has become one of the most important advances in stroke secondary prevention. Objective: To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. Methods: We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. Results: Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. Conclusions: Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.

RESUMO Introdução: A terapia com estatinas tornou-se um dos avanços mais importantes na prevenção secundária do acidente vascular cerebral (AVC). Objetivo: Fornecer evidências de dados do mundo real para avaliar associações detalhadas entre a prevenção secundária do AVC e o uso de estatinas no Brasil. Métodos: Realizamos um estudo de coorte prospectivo, incluindo pacientes consecutivos com diagnóstico de AVC isquêmico. Os indivíduos foram classificados em grupos sem estatinas, sinvastatina 20 mg, sinvastatina 40 mg e estatina de alta potência. Também registramos o início da terapêutica com estatinas, o uso prévio de estatinas, a adesão à medicação e se houve descontinuação da terapia. Após dois anos, foram avaliados o resultado funcional, a recorrência do AVC, os principais eventos cardiovasculares e a mortalidade. Resultados: Entre os 513 pacientes incluídos em nossa coorte, havia 96 (18,7%) pacientes sem estatinas, 169 (32,9%) com sinvastatina 20 mg, 202 (39,3%) com sinvastatina 40 mg e 46 (9,0%) com estatinas de alta potência. Pacientes sem estatinas apresentaram maior risco de recorrência de AVC e piores resultados funcionais. Em relação à etiologia, foram observadas evidências do benefício das estatinas nos casos de aterosclerose de grandes artérias, oclusão de pequenos vasos e AVC de causa indeterminada. Aqueles com baixa adesão às estatinas ou que interromperam o uso tiveram pior prognóstico após o AVC, enquanto o início precoce do uso de estatinas foi associado a melhores resultados. Pacientes com sinvastatina 40 mg e estatinas de alta potência apresentaram melhor recuperação funcional ao longo do período de acompanhamento. Conclusões: As estatinas desempenham um importante papel no tratamento do AVC isquêmico, prevenindo sua recorrência e eventos cardiovasculares e melhorando o desempenho funcional.

Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil.

BACKGROUND: Statin therapy has become one of the most important advances in stroke secondary prevention. OBJECTIVE: To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. METHODS: We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS: Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. CONCLUSIONS: Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.

The influence of statins on the risk of post-stroke epilepsy.

BACKGROUND: Currently, statins are widely used for secondary prevention of stroke due to their pleiotropic neuroprotective effects. Epilepsy is a common complication of cerebrovascular diseases. The purpose of this study was to evaluate the effect of statin therapy on the occurrence of post-stroke epilepsy (PSE). METHODS: In this prospective cohort study, patients who suffered an ischemic stroke and without history of epilepsy before stroke were enrolled. At baseline, patients were classified according to the particularities of statin therapy. Statin use onset and adherence to treatment were registered as well. After a follow-up period of 1 year, we assessed the occurrence of seizures and PSE. RESULTS: Among the 477 patients included in our cohort, there were 91 (19.1%) patients without statins, 160 (33.5%) with simvastatin 20 mg, 180 (37.7%) with simvastatin 40 mg, and 46 (9.6%) with high-potency statins. Overall, PSE emerged in 53 (11.1%) patients. PSE was significantly more prevalent among those who did not receive statins and those with lower doses of simvastatin. Acute onset of statin use was associated with reduced odds of having PSE. CONCLUSION: Adequate treatment with statins after stroke may lower the risk of PSE.