Effects of Combination Therapy of Statins and Probucol or Asprin on Ischemic Stroke
|School||Tianjin Medical University|
|Keywords||atorvastatin simvastatin probucol aspirin ischemic stroke|
Object:To observe the therapeutic and preventive effect of combining statins with probucol and aspirin on ischemic stroke.Methods:1. Effect of combining probucol with statins in ischemic stroke.162patients of emerging ischemic stroke were randomly selected in this study. All patients in research group, diagnosed by CT and MRI inspection, which comply with the diagnostic criteria of cerebral infarction amended by the fourth national conference. All of them signed informed consent document. And this study had unambiguous exclusion criteria.90patients from all162cases were divided into3groups, atorvastatin+probucol group(n=30), atorvastatin group (n=30), control group(n=30), observing for6months. Difference of every clinical index of these three groups was insignificant on admission. The three groups’blood lipids (including total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C)), hs-CRP, pregnancy and related plasma protein (PAPP-A) level, intima-media thickness (IMT) and area of carotid intima of atherosclerotic plaque were tested before and after treatment respectively. On the admission day and one month after admission the neurological deficit scores was assessed, and the relationship between hs-CRP and the U.S. National Institutes of Health Stroke Scale(NIHSS)score and activities of daily living scale Barthel Index(BI) was analyzed. The other72patients of all162cases were randomly divided into2group, simvastatin+probucol group (n=37) and simvastatin group (n=35), observing for1months. Carotid artery lumen diameter, peak systolic velocity (SV), diastolic peak flow velocity (DV), resistance index (RI), oxidized low-density lipoprotein (oxLDL), superoxide dismutase (SOD), andmalondialdehyde (MDA) were examined before and after treatment.2. Effect of combining aspirin with statins in ischemic stroke.168patients of emerging ischemic stroke were randomly selected in this study. All patients in research group, diagnosed by CT and MRI inspection, which comply with the diagnostic criteria of cerebral infarction amended by the fourth national conference. All of them signed informed consent document. And this study had unambiguous exclusion criteria. All patient in this study ware divided into2groups, atorvastatin+aspirin group (n=84) and atorvastatin group (n=84). Difference of every clinical index of these two groups was insignificant on admission.48h relapse after ischemic stroke symptom onset, living activity after receiving treatment for6months, blood lipids level and Cerebrovascular events during hospitalization and6months follow-up were observed.Result:1.A significant drop of TC(P<0.01),TG(P<0.01),LDL-C(P<0.01), IMT(P<0.01), area of Carotid intima of atherosclerotic plaque(P<0.01), PAPP-A (P<0.01),hs-CRP(P<0.01) and a significant rise of HDL-C(P<0.01)were observed in atorvastatin+probucol group. All parameters were improved significantly comparing with atorvastatin alone. Neurological deficit score of these two groups had significantly different after treatment (P<0.01). Combination therapy had better efficacy. The seriousness of ischemic stroke on admission day and1month of treatment was associated with the hs-CRP levels significantly. In simvastatin+probucol group, carotid artery lumen diameter, SV, DV and SOD were significantly up-regulated (P<0.05) and RI, oxLDL and MDA down-regulated (P<0.05). In simvastatin group, all these parameter had no significant difference before and after treatment (P>0.05).2.Atorvastatin combined with aspirin had better performance with48h relapse after ischemic stroke symptom onset than atorvastatin alone..A significant drop of TC(P<0.01),TG(P<0.01),LDL-C(P<0.01) and a significant rise of HDL-C(P<0.01)were observed in atorvastatin+aspirin group after6months treatment. Even more, it performed better than atorvastatin group (P<0.05). Atorvastatin+aspirin group had greater proportion of patients with high score in living activity (ADL1, ADL2) than atorvastatin group(P<0.05). Cerebrovascular events during hospitalization and6months follow-up improved significantly comparing with atorvastatin group.Conclusion:Short-term use of statins combining with probucol or anti-platelet drugs, even single use of statins, could have a significant effect on ischemic stroke, improve endothelial function, stable atherosclerotic plaques, blood lipid, living activity and reduce adverse cerebrovascular event and recurrence rate. Combining with Probucol or antiplatelet could have more significant efficacy.