Marta Masztalewicz

Potential role of statins in the intracerebral hemorrhage and subarachnoid hemorrhage

Statins are used in primary and secondary prevention of cardiovascular episodes. Most of recent studies regard ischemic stroke. There are more emerging results of studies suggesting usefulness of these drugs in the other types of stroke e.g. intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Searching for new methods of treatment is important, because both ICH and SAH lead to poor prognosis and severe psychomotor disability. The unquestionable role of inflammatory factors in the pathogenesis of these disorders justifies considering statin treatment. Previous results are contradictory, thus in present study we review results of studies and try to explain the potential pathomechanism of statin use in hemorrhagic strokes.

Anti-oxLDL antibodies are clinically insignificant for stroke patients.

Abstract Objectives: The question about anti-oxidized low-density lipoprotein antibodies (anti-oxLDL Abs) involvement in the pathogenesis of atherosclerosis-related ischemic stroke is still open. The aim of this study was to determine how anti-oxLDL Abs are involved in the pathogenesis of atherosclerosis-related ischemic stroke and identify the main risk factors for stroke, such as arterial hypertension, diabetes mellitus type 2, dyslipidemia, and atherosclerotic changes in the common and internal carotid arteries. Material and Methods: A total of 40 stroke patients and 25 age- and sex-matched healthy individuals were included in the study. For each subject, IgG anti-oxLDL Abs expression in peripheral blood was assessed and analyzed in relation to clinical data, carotid Doppler ultrasonography results, and results of peripheral blood laboratory tests, including inflammatory parameters and lipid profile. Results: The blood level of assessed antibodies was significantly higher in stroke patients than in control group. It did not relate to stroke severity and stroke outcome. The relationship between anti-oxLDL Abs and carotid plaques hyperechogenicity was observed. The antibodies concentration was significantly higher in patients with diabetes mellitus type 2 and also positively correlated with C-reactive protein blood level. However, multiple regression method did not confirm their independent influence. Discussion: Patients with atherogenic ischemic stroke may have significantly higher anti-oxLDL Abs concentrations. This should be interpreted as an attempt to limit the consequences of oxLDL production; however, this phenomenon does not seem to protect patients against cerebrovascular events.

Association between selected gene polymorphisms and statin metabolism, risk of ischemic stroke and cardiovascular disorders.

Statins are increasingly widely used in primary and secondary prevention of cardiovascular disorders, including ischemic stroke. The initial studies regarded mainly coronary heart disease, but recently more attention has been paid to statin use in ischemic stroke, including primary and secondary prevention as well as the acute phase treatment. Besides their main hypolipemic activity, statins have been proved to have immunomodulating properties that are called a pleiotropic effect. Drug metabolism is under genetic influence, exemplified by the single nucleotide polymorphisms (SNPs). This also applies to statins. Pharmacogenetic studies are conducted in many disorders including stroke. The aim of this study was to review selected common genetic variants in lipid or statin metabolism-related genes and indicate associations with cardiovascular disorders, especially with ischemic stroke. We present available data of SNPs in regard to the most significant and promising proteins such as cytochrome P450, ATPase superfamily, organic anion transporter family, apolipoprotein E, lipoprotein-associated phospholipase A2, lipoprotein(a), LDLR, proprotein convertase subtilisin/kexin type 9, HMGCR, and CETP. A presentation of particular SNPs may help in future studies to aim for individual and thus more effective statin therapy in stroke patients.

The emotional stress and risk of ischemic stroke

Stroke is the second leading cause of death worldwide, and the leading cause of acquired disability in adults in most regions. There have been distinguished modifiable and non-modifiable risk factors of stroke. Among them the emotional stress was presented as a risk factor. The aim of this review was to present available data regarding the influence of acute and chronic mental stress on the risk of ischemic stroke as well as discussing the potential pathomechanisms of such relationship. There is an evident association between both acute and chronic emotional stress and risk of stroke. Several potential mechanisms are discussed to be the cause. Stress can increase the cerebrovascular disease risk by modulating symphaticomimetic activity, affecting the blood pressure reactivity, cerebral endothelium, coagulation or heart rhythm. The emotional stress seems to be still underestimated risk factor in neurological practice and research. Further studies and analyses should be provided for better understanding of this complex, not fully known epidemiological problem.

Clinical characteristics of early and late recurrent ischaemic stroke.

BACKGROUND AND PURPOSE The aim of the study was to search for differences between clinical characteristics of recurrent ischaemic stroke which occurred within the fifth year after the first event or later, and early recurrence, i.e. within the first year after first-ever ischaemic stroke. We also tried to determine prognostic factors of late recurrent ischaemic episodes. MATERIAL AND METHODS The patients were divided into two groups: group I comprised 124 individuals with recurrence within the first year, and group II - 98 individuals in whom the recurrent episode appeared within the fifth year or later. RESULTS A significantly higher percentage of patients in group I demonstrated evident stenosis (70% or more) of internal carotid artery ipsilateral to stroke (p = 0.023). In this group more cardioembolic strokes were found compared to group II, while in the latter, predominantly lacunar strokes appeared (p = 0.046 and 0.0002, respectively). Group II patients significantly more frequently reported acetylsalicylic acid application, including systematic drug use (p = 0.001). No evident differences were found between groups considering other important non-modifiable and modifiable risk factors of stroke. CONCLUSIONS Small differences between risk factors of ischaemic stroke profiles in patients with early and late recurrent episodes do not allow us to distinguish unequivocally a group of patients with better prognosis regarding the time of recurrent stroke. Use of antiplatelet drugs, either systematic or non-systematic, and lacunar stroke are independent, positive prognostic factors of delay of potential recurrent stroke.

High expression of CX3C chemokine receptor 1 (CX3CR1) in human carotid plaques is associated with vulnerability of the lesions

Introduction: In data based on ex vivo studies and animal models, fractalkine is considered an important mediator in the development and destabilization of atherosclerotic plaques. We do not know how it is associated with human carotid plaques morphology. Material and methods: The study included 126 carotid plaques taken from 126 patients who underwent endarterectomy of internal carotid arteries. We assessed the following characteristics: inflammatory infiltration, connective tissue elements, foam cells, lipid core, plaque vascularisation, calcifications, intraplaque haemorrhage, thrombi built into the plaque structure, and mural thrombi. CX3CR1 expression in plaques as a response to fractalkine was assessed. Results: Compared to those with a low fractalkine receptor expression, plaques with its high expression exhibited more intensive inflammatory infiltrations. They were more likely to contain inflammatory than fibrous components. They were characterized by a large foam cell component and were less calcified. Intraplaque haemorrhages, the large lipid core and mural as well as intraplaque thrombi were more frequent within them. Conclusions: High expression of the fractalkine receptor within human carotid plaques is associated with morphological parameters of plaque instability. Thus we conclude that fractalkine may be involved in vulnerability of human carotid plaque. .

Early Emergency Medical Service Calls for Stroke: Was the Long-Term Education Program Based on the Experience of West Pomerania Successful?

BACKGROUND Our objectives are to investigate whether the percentage of early emergency calls for stroke had increased and to assess current factors determining the time of deciding to seek medical help in the event of early stroke symptoms. MATERIALS AND METHODS We analyzed data concerning the decision to call for medical help in relation to observed stroke symptoms. Group I comprised 287 people who made the decision to call emergency medical service (EMS) in the first 10 minutes after observing stroke symptoms. Group II included 275 people who called EMS after that time. Data from the current database (2013-2014) were compared with relevant data from the period 2003-2005. RESULTS In 2013-2014, awareness of stroke signs was 2.5 times greater than in 2003-2005. Among the groups of early and delayed EMS calls during 2003-2005 and 2013-2014, there were no significant differences in the number of people who suspected stroke. Advanced patient age, young caller age, hemiparesis, facial weakness, and the severity of neurological deficit were independent factors that correlated strongly with an early EMS call, whereas feelings of numbness and dizziness correlated significantly with delayed EMS calls. CONCLUSIONS In the West Pomeranian community, general knowledge of stroke is not a significant factor when making appropriate decisions at the onset of stroke symptoms. The education campaign regarding the initial symptoms of stroke and the possible fatal consequences appears to have been ineffective.