Statins in Stroke

Konstantinos       Aznaouridis; Constantina       Masoura; Charalambos       Vlachopoulos; Dimitris       Tousoulis

doi:10.2174/0929867326666190620104539

Abstract

Background: Stroke is a major cause of mortality and disability in modern societies. Statins are effective medications in decreasing cardiovascular events through lipid lowering and pleiotropic effects.

Objective: To summarize current evidence regarding the role of statins in the prevention and management of stroke.

Methods: A narrative review of current evidence regarding the effect of statins in stroke management. Electronic searches of MEDLINE, EMBASE and Cochrane Databases were performed.

Results: In primary prevention of stroke in patients with risk factors but no established cardiovascular disease, potent statins such as atorvastatin and rosuvastatin have shown some benefits, but the clinical relevance of this effect is questionable. In populations at higher risk of stroke, such as patients with established coronary heart disease, the majority of relevant studies have shown a beneficial effect of statins in preventing stroke. Similarly, in patients with a previous cerebrovascular event, there is a clear benefit of statins for the prevention of recurrent events. The use of statins is not associated with an increased risk of intracranial bleeding in primary prevention studies. There may be an increased incidence of non-fatal hemorrhagic stroke with high dose statins in patients with a previous cerebrovascular event. Patients who experience a stroke while on statins should not discontinue statins. In addition, statins are associated with better survival and improved functional outcome when administered during the acute phase of stroke in statin-naive patients. In contrast, statins do not confer any benefit in patients with acute ischemic stroke who receive thrombolysis.

Conclusion: Treatment with statins prevents ischemic stroke, especially in patients with high cardiovascular risk and established atherosclerotic disease. It seems that both lipid lowering and pleiotropic effects contribute to these effects.

Keywords: Statins, stroke, cerebrovascular event, ischemic stroke, hemorrhagic stroke, mortality, atherosclerotic disease.

« Previous

[1] 

http://www.who.int/mediacentre/factsheets/fs310/en/ assessed 3rd June. 2017.
[2] 
Meschia, J.F.; Bushnell, C.; Boden-Albala, B.; Braun, L.T.; Bravata, D.M.; Chaturvedi, S.; Creager, M.A.; Eckel, R.H.; Elkind, M.S.; Fornage, M.; Goldstein, L.B.; Greenberg, S.M.; Horvath, S.E.; Iadecola, C.; Jauch, E.C.; Moore, W.S.; Wilson, J.A. American heart association stroke council council on cardiovascular and stroke nursing council on clinical cardiology council on functional genomics and translational biology council on hypertension. Guidelines for the primary prevention of stroke: A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke,  2014, 45(12), 3754-3832.
[http://dx.doi.org/10.1161/STR.0000000000000046] [PMID:  25355838] 
[3] 
Mihaylova, B.; Emberson, J.; Blackwell, L.; Keech, A.; Simes, J.; Barnes, E.H.; Voysey, M.; Gray, A.; Collins, R.; Baigent, C. Cholesterol Treatment Trialists’ (CTT) Collaborators.The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet,  2012, 380(9841), 581-590.
[http://dx.doi.org/10.1016/S0140-6736(12)60367-5] [PMID:  22607822] 
[4] 
Hong, K.S.; Lee, J.S. Statins in acute ischemic stroke: a systematic review. J. Stroke,  2015, 17(3), 282-301.
[http://dx.doi.org/10.5853/jos.2015.17.3.282] [PMID:  26437994] 
[5] 
Blum, A. HMG-CoA reductase inhibitors (statins), inflammation, and endothelial progenitor cells-New mechanistic insights of atherosclerosis. Biofactors,  2014, 40(3), 295-302.
[http://dx.doi.org/10.1002/biof.1157] [PMID:  25077301] 
[6] 
Cimino, M.; Gelosa, P.; Gianella, A.; Nobili, E.; Tremoli, E.; Sironi, L. Statins: multiple mechanisms of action in the ischemic brain. Neuroscientist,  2007, 13(3), 208-213.
[http://dx.doi.org/10.1177/1073858406297121] [PMID:  17519364] 
[7] 
Iso, H.; Jacobs, D.R., Jr; Wentworth, D.; Neaton, J.D.; Cohen, J.D. Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial. N. Engl. J. Med.,  1989, 320(14), 904-910.
[http://dx.doi.org/10.1056/NEJM198904063201405] [PMID:  2619783] 
[8] 
Shepherd, J.; Cobbe, S.M.; Ford, I.; Isles, C.G.; Lorimer, A.R.; MacFarlane, P.W.; McKillop, J.H.; Packard, C.J. West of Scotland Coronary Prevention Study Group.Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N. Engl. J. Med.,  1995, 333(20), 1301-1307.
[http://dx.doi.org/10.1056/NEJM199511163332001] [PMID:  7566020] 
[9] 
ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group.The antihypertensive and lipid-lowering treatment to prevent heart attack trial. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA,  2002, 288(23), 2998-3007.
[http://dx.doi.org/10.1001/jama.288.23.2998] [PMID:  12479764] 
[10] 
Nakamura, H.; Arakawa, K.; Itakura, H.; Kitabatake, A.; Goto, Y.; Toyota, T.; Nakaya, N.; Nishimoto, S.; Muranaka, M.; Yamamoto, A.; Mizuno, K.; Ohashi, Y. MEGA Study Group.Primary prevention of cardiovascular disease with pravastatin in Japan (MEGA Study): a prospective randomised controlled trial. Lancet,  2006, 368(9542), 1155-1163.
[http://dx.doi.org/10.1016/S0140-6736(06)69472-5] [PMID:  17011942] 
[11] 
Sever, P.S.; Dahlöf, B.; Poulter, N.R.; Wedel, H.; Beevers, G.; Caulfield, M.; Collins, R.; Kjeldsen, S.E.; Kristinsson, A.; McInnes, G.T.; Mehlsen, J.; Nieminen, M.; O’Brien, E.; Ostergren, J. ASCOT investigators. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial--Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet,  2003, 361(9364), 1149-1158.
[http://dx.doi.org/10.1016/S0140-6736(03)12948-0] [PMID:  12686036] 
[12] 
Ridker, P.M.; Danielson, E.; Fonseca, F.A.; Genest, J.; Gotto, A.M., Jr; Kastelein, J.J.; Koenig, W.; Libby, P.; Lorenzatti, A.J.; MacFadyen, J.G.; Nordestgaard, B.G.; Shepherd, J.; Willerson, J.T.; Glynn, R.J. JUPITER Study Group.Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N. Engl. J. Med.,  2008, 359(21), 2195-2207.
[http://dx.doi.org/10.1056/NEJMoa0807646] [PMID:  18997196] 
[13] 
Yebyo, H.G.; Aschmann, H.E.; Kaufmann, M.; Puhan, M.A. Comparative effectiveness and safety of statins as a class and of specific statins for primary prevention of cardiovascular disease: A systematic review, meta-analysis, and network meta-analysis of randomized trials with 94,283 participants. Am. Heart J.,  2019, 210, 18-28.
[http://dx.doi.org/10.1016/j.ahj.2018.12.007] [PMID:  30716508] 
[14] 
Sacks, F.M.; Pfeffer, M.A.; Moye, L.A.; Rouleau, J.L.; Rutherford, J.D.; Cole, T.G.; Brown, L.; Warnica, J.W.; Arnold, J.M.; Wun, C.C.; Davis, B.R.; Braunwald, E. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and recurrent events trial investigators. N. Engl. J. Med.,  1996, 335(14), 1001-1009.
[http://dx.doi.org/10.1056/NEJM199610033351401] [PMID:  8801446] 
[15] 
White, H.D.; Simes, R.J.; Anderson, N.E.; Hankey, G.J.; Watson, J.D.; Hunt, D.; Colquhoun, D.M.; Glasziou, P.; MacMahon, S.; Kirby, A.C.; West, M.J.; Tonkin, A.M. Pravastatin therapy and the risk of stroke. N. Engl. J. Med.,  2000, 343(5), 317-326.
[http://dx.doi.org/10.1056/NEJM200008033430502] [PMID:  10922421] 
[16] 
The Scandinavian Simvastatin Survival Study (4S). Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease. Lancet,  1994, 344, 1383-1389.
[PMID:  7968073] 
[17] 
Athyros, V.G.; Papageorgiou, A.A.; Mercouris, B.R.; Athyrou, V.V.; Symeonidis, A.N.; Basayannis, E.O.; Demitriadis, D.S.; Kontopoulos, A.G. Treatment with atorvastatin to the National Cholesterol Educational Program goal versus ‘usual’ care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study. Curr. Med. Res. Opin.,  2002, 18(4), 220-228.
[http://dx.doi.org/10.1185/030079902125000787] [PMID:  12201623] 
[18] 
de Lemos, J.A.; Blazing, M.A.; Wiviott, S.D.; Lewis, E.F.; Fox, K.A.; White, H.D.; Rouleau, J.L.; Pedersen, T.R.; Gardner, L.H.; Mukherjee, R.; Ramsey, K.E.; Palmisano, J.; Bilheimer, D.W.; Pfeffer, M.A.; Califf, R.M.; Braunwald, E. Investigators. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA,  2004, 292(11), 1307-1316.
[http://dx.doi.org/10.1001/jama.292.11.1307] [PMID:  15337732] 
[19] 
Koren, M.J.; Hunninghake, D.B.  ALLIANCE Investigators.Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics: the alliance study. J. Am. Coll. Cardiol.,  2004, 44(9), 1772-1779.
[http://dx.doi.org/10.1016/j.jacc.2004.07.053] [PMID:  15519006] 
[20] 
Corvol, J.C.; Bouzamondo, A.; Sirol, M.; Hulot, J.S.; Sanchez, P.; Lechat, P. Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. Arch. Intern. Med.,  2003, 163(6), 669-676.
[http://dx.doi.org/10.1001/archinte.163.6.669] [PMID:  12639199] 
[21] 
O’Regan, C.; Wu, P.; Arora, P.; Perri, D.; Mills, E.J. Statin therapy in stroke prevention: a meta-analysis involving 121,000 patients. Am. J. Med.,  2008, 121(1), 24-33.
[http://dx.doi.org/10.1016/j.amjmed.2007.06.033] [PMID:  18187070] 
[22] 
Amarenco, P.; Bogousslavsky, J.; Callahan, A., III; Goldstein, L.B.; Hennerici, M.; Rudolph, A.E.; Sillesen, H.; Simunovic, L.; Szarek, M.; Welch, K.M.; Zivin, J.A. Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators.High-dose atorvastatin after stroke or transient ischemic attack. N. Engl. J. Med.,  2006, 355(6), 549-559.
[http://dx.doi.org/10.1056/NEJMoa061894] [PMID:  16899775] 
[23] 
Collins, R.; Armitage, J.; Parish, S.; Sleight, P.; Peto, R. Heart Protection Study Collaborative Group.Effects of cholesterol-lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet,  2004, 363(9411), 757-767.
[http://dx.doi.org/10.1016/S0140-6736(04)15690-0] [PMID:  15016485] 
[24] 
Hosomi, N.; Nagai, Y.; Kohriyama, T.; Ohtsuki, T.; Aoki, S.; Nezu, T.; Maruyama, H.; Sunami, N.; Yokota, C.; Kitagawa, K.; Terayama, Y.; Takagi, M.; Ibayashi, S.; Nakamura, M.; Origasa, H.; Fukushima, M.; Mori, E.; Minematsu, K.; Uchiyama, S.; Shinohara, Y.; Yamaguchi, T.; Matsumoto, M. J-STARS Collaborators. J-STARS Collaborators. The Japan Statin Treatment Against Recurrent Stroke (J-STARS): A multicenter, randomized, open-label, parallel-group study. EBioMedicine,  2015, 2(9), 1071-1078.
[http://dx.doi.org/10.1016/j.ebiom.2015.08.006] [PMID:  26501105] 
[25] 
Hosomi, N.; Kitagawa, K.; Nagai, Y.; Nakagawa, Y.; Aoki, S.; Nezu, T.; Kagimura, T.; Maruyama, H.; Origasa, H.; Minematsu, K.; Uchiyama, S.; Matsumoto, M. J-STARS Collaborators. J-STARS Collaborators. Desirable low-density lipoprotein cholesterol levels for preventing stroke recurrence: a post hoc analysis of the J-STARS Study (Japan Statin Treatment Against Recurrent Stroke). Stroke,  2018, 49(4), 865-871.
[http://dx.doi.org/10.1161/STROKEAHA.117.018870] [PMID:  29511130] 
[26] 
Hosomi, N.; Nagai, Y.; Kitagawa, K.; Nakagawa, Y.; Aoki, S.; Nezu, T.; Kagimura, T.; Maruyama, H.; Origasa, H.; Minematsu, K.; Uchiyama, S.; Matsumoto, M. J-STARS collaborators. J-STARS collaborators. Pravastatin reduces the risk of atherothrombotic stroke when administered within six months of an initial stroke event. J. Atheroscler. Thromb.,  2018, 25(3), 262-268.
[http://dx.doi.org/10.5551/jat.40196] [PMID:  28924103] 
[27] 
Tramacere, I.; Boncoraglio, G.B.; Banzi, R.; Del Giovane, C.; Kwag, K.H.; Squizzato, A.; Moja, L. Comparison of statins for secondary prevention in patients with ischemic stroke or transient ischemic attack: a systematic review and network meta-analysis. BMC Med.,  2019, 17(1), 67.
[http://dx.doi.org/10.1186/s12916-019-1298-5] [PMID:  30914063] 
[28] 
Antoniou, T.; Macdonald, E.M.; Yao, Z.; Hollands, S.; Gomes, T.; Tadrous, M.; Mamdani, M.M.; Juurlink, D.N. Canadian Drug Safety and Effectiveness Research Network. Association between statin use and ischemic stroke or major hemorrhage in patients taking dabigatran for atrial fibrillation. CMAJ,  2017, 189(1), E4-E10.
[http://dx.doi.org/10.1503/cmaj.160303] [PMID:  28246253] 
[29] 
Pandit, A.K.; Kumar, P.; Kumar, A.; Chakravarty, K.; Misra, S.; Prasad, K. High-dose statin therapy and risk of intracerebral hemorrhage: A meta-analysis. Acta Neurol. Scand.,  2016, 134(1), 22-28.
[http://dx.doi.org/10.1111/ane.12540] [PMID:  26647879] 
[30] 
Ziff, O.J.; Banerjee, G.; Ambler, G.; Werring, D.J. Statins and the risk of intracerebral haemorrhage in patients with stroke: systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry,  2019, 90(1), 75-83.
[http://dx.doi.org/10.1136/jnnp-2018-318483] [PMID:  30150320] 
[31] 
Åsberg, S.; Farahmand, B.; Henriksson, K.M.; Appelros, P. Statins as secondary preventives in patients with intracerebral hemorrhage. Int. J. Stroke, 2018.
[http://dx.doi.org/10.1177/1747493018816476] [PMID:  30484749] 
[32] 
Jung, M.; Lee, S. Effects of statin therapy on the risk of intracerebral hemorrhage in Korean patients with hyperlipidemia. Pharmacotherapy,  2019, 39(2), 129-139.
[http://dx.doi.org/10.1002/phar.2211] [PMID:  30585646] 
[33] 
Yi, X.; Han, Z.; Wang, C.; Zhou, Q.; Lin, J. Statin and aspirin pretreatment are associated with lower neurological deterioration and platelet activity in patients with acute ischemic stroke. J. Stroke Cerebrovasc. Dis.,  2017, 26(2), 352-359.
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.09.030] [PMID:  27793535] 
[34] 
Safouris, A.; Katsanos, A.H.; Kerasnoudis, A.; Krogias, C.; Kinsella, J.A.; Sztajzel, R.; Lambadiari, V.; Deftereos, S.; Kargiotis, O.; Sharma, V.K.; Demchuk, A.M.; Saqqur, M.; McCabe, D.J.H.; Tsivgoulis, G. Statin pretreatment and microembolic signals in large artery atherosclerosis. Stroke,  2018, 49(8), 1992-1995.
[http://dx.doi.org/10.1161/STROKEAHA.118.021542] [PMID:  29991656] 
[35] 
Chen, X.; Zhuang, X.; Peng, Z.; Yang, H.; Chen, L.; Yang, Q. Intensive statin therapy for acute ischemic stroke to reduce the number of microemboli: a preliminary, randomized controlled study. Eur. Neurol.,  2018, 80(3-4), 163-170.
[http://dx.doi.org/10.1159/000494989] [PMID:  30485853] 
[36] 
Elkind, M.S.; Sacco, R.L.; MacArthur, R.B.; Fink, D.J.; Peerschke, E.; Andrews, H.; Neils, G.; Stillman, J.; Corporan, T.; Leifer, D.; Cheung, K. The Neuroprotection with Statin Therapy for Acute Recovery Trial (NeuSTART): an adaptive design phase I dose-escalation study of high-dose lovastatin in acute ischemic stroke. Int. J. Stroke,  2008, 3(3), 210-218.
[http://dx.doi.org/10.1111/j.1747-4949.2008.00200.x] [PMID:  18705902] 
[37] 
Lee, M.; Saver, J.L.; Wu, Y.L.; Tang, S.C.; Lee, J.D.; Rao, N.M.; Wang, H.H.; Jeng, J.S.; Lee, T.H.; Chen, P.C.; Ovbiagele, B. Utilization of statins beyond the initial period after stroke and 1-year risk of recurrent stroke. J. Am. Heart Assoc.,  2017, 6(8)e005658
[http://dx.doi.org/10.1161/JAHA.117.005658] [PMID:  28768645] 
[38] 
Montaner, J.; Chacón, P.; Krupinski, J.; Rubio, F.; Millán, M.; Molina, C.A.; Hereu, P.; Quintana, M.; Alvarez-Sabín, J. Simvastatin in the acute phase of ischemic stroke: a safety and efficacy pilot trial. Eur. J. Neurol.,  2008, 15(1), 82-90.
[http://dx.doi.org/10.1111/j.1468-1331.2007.02015.x] [PMID:  18070096] 
[39] 
Ní Chróinín, D.; Callaly, E.L.; Duggan, J.; Merwick, Á.; Hannon, N.; Sheehan, Ó.; Marnane, M.; Horgan, G.; Williams, E.B.; Harris, D.; Kyne, L.; McCormack, P.M.; Moroney, J.; Grant, T.; Williams, D.; Daly, L.; Kelly, P.J. Association between acute statin therapy, survival, and improved functional outcome after ischemic stroke: the North Dublin Population Stroke Study. Stroke,  2011, 42(4), 1021-1029.
[http://dx.doi.org/10.1161/STROKEAHA.110.596734] [PMID:  21372311] 
[40] 
Heo, J.H.; Song, D.; Nam, H.S.; Kim, E.Y.; Kim, Y.D.; Lee, K.Y.; Lee, K.J.; Yoo, J.; Kim, Y.N.; Lee, B.C.; Yoon, B.W.; Kim, J.S.  EUREKA Investigators.EUREKA Investigators. Effect and safety of rosuvastatin in acute ischemic stroke. J. Stroke,  2016, 18(1), 87-95.
[http://dx.doi.org/10.5853/jos.2015.01578] [PMID:  26846760] 
[41] 
Ní Chróinín, D.; Asplund, K.; Åsberg, S.; Callaly, E.; Cuadrado-Godia, E.; Díez-Tejedor, E.; Di Napoli, M.; Engelter, S.T.; Furie, K.L.; Giannopoulos, S.; Gotto, A.M., Jr; Hannon, N.; Jonsson, F.; Kapral, M.K.; Martí-Fàbregas, J.; Martínez-Sánchez, P.; Milionis, H.J.; Montaner, J.; Muscari, A.; Pikija, S.; Probstfield, J.; Rost, N.S.; Thrift, A.G.; Vemmos, K.; Kelly, P.J. Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials. Stroke,  2013, 44(2), 448-456.
[http://dx.doi.org/10.1161/STROKEAHA.112.668277] [PMID:  23287777] 
[42] 
Kotlęga, D.; Gołąb-Janowska, M.; Meller, A.; Bajer-Czajkowska, A.; Zembroń-Łacny, A.; Nowacki, P.; Banach, M. Beneficial effects of pre-stroke statins use in cardioembolic stroke patients with atrial fibrillation: a hospital-based retrospective analysis. Arch. Med. Sci.,  2019, 15(2), 385-392.
[http://dx.doi.org/10.5114/aoms.2019.82925] [PMID:  30899291] 
[43] 
Montaner, J.; Bustamante, A.; García-Matas, S.; Martínez-Zabaleta, M.; Jiménez, C.; de la Torre, J.; Rubio, F.R.; Segura, T.; Masjuán, J.; Cánovas, D.; Freijo, M.; Delgado-Mederos, R.; Tejada, J.; Lago, A.; Bravo, Y.; Corbeto, N.; Giralt, D.; Vives-Pastor, B.; de Arce, A.; Moniche, F.; Delgado, P.; Ribó, M.  STARS Investigators.STARS Investigators. Combination of thrombolysis and statins in acute stroke is safe: Results of the STARS randomized trial (stroke treatment with acute reperfusion and simvastatin). Stroke,  2016, 47(11), 2870-2873.
[http://dx.doi.org/10.1161/STROKEAHA.116.014600] [PMID:  27758944] 
[44] 
Clua-Espuny, J.L.; Abilleira, S.; Queralt-Tomas, L.; Gonzalez-Henares, A.; Gil-Guillen, V.; Muria-Subirats, E.; Ballesta-Ors, J. Gonzalez-Henares, A.; Gil-Guillen, V.; Muria-Subirats, E.; Ballesta-Ors, J. Long- term survival after stroke according to reperfusion therapy, cardiovascular therapy and gender. Cardiol. Res.,  2019, 10(2), 89-97.
[http://dx.doi.org/10.14740/cr839] [PMID:  31019638] 
[45] 
Kang, H.J.; Bae, K.Y.; Kim, S.W.; Kim, J.T.; Park, M.S.; Cho, K.H.; Kim, J.M. Effects of interleukin-6, interleukin-18, and statin use, evaluated at acute stroke, on post-stroke depression during 1-year follow-up. Psychoneuroendocrinology,  2016, 72, 156-160.
[http://dx.doi.org/10.1016/j.psyneuen.2016.07.001] [PMID:  27428088] 
[46] 
Beckman, J.A.; Liao, J.K.; Hurley, S.; Garrett, L.A.; Chui, D.; Mitra, D.; Creager, M.A. Atorvastatin restores endothelial function in normocholesterolemic smokers independent of changes in low-density lipoprotein. Circ. Res.,  2004, 95(2), 217-223.
[http://dx.doi.org/10.1161/01.RES.0000134628.96682.9b] [PMID:  15178637] 
[47] 
Oesterle, A.; Liao, J.K. The pleiotropic effects of statins - from coronary artery disease and stroke to atrial fibrillation and ventricular tachyarrhythmia. Curr. Vasc. Pharmacol.,  2019, 17(3), 222-232.
[http://dx.doi.org/10.2174/1570161116666180817155058] [PMID:  30124154] 
[48] 
Vlachopoulos, C.; Aznaouridis, K.; Dagre, A.; Vasiliadou, C.; Masoura, C.; Stefanadi, E.; Skoumas, J.; Pitsavos, C.; Stefanadis, C. Protective effect of atorvastatin on acute systemic inflammation-induced endothelial dysfunction in hypercholesterolaemic subjects. Eur. Heart J.,  2007, 28(17), 2102-2109.
[http://dx.doi.org/10.1093/eurheartj/ehm247] [PMID:  17597050] 

Rights & Permissions Print Cite

Article Metrics

65

9

Journal Information

For Authors

For Editors

For Reviewers

Explore Articles

Open Access

Open Access Articles

For Visitors

DOI https://dx.doi.org/10.2174/0929867326666190620104539	Print ISSN 0929-8673
Publisher Name Bentham Science Publisher	Online ISSN 1875-533X

Current Medicinal Chemistry

Statins in Stroke

Abstract Play Pause

Related Journals

Related Books

Related Articles

Abstract