Abstract

The objective of the present study is to investigate the effects of anticoagulation and inhibition of platelet aggregation, which is strongly related with ischemic stroke, with aspirin 100 mg/once daily and clopidogrel 75 mg/once daily together with atorvastatin 80 mg/once daily then evaluating the event free survival in patients who had stroke with LDL-C > 130 mg/dl. An hypolipidaemic diet was given to every patient. As known statins other than reducing LDL-C (silent killer), has many other effects characterized by a wider and wider checklist: reduction of plasmatic levels of C-reactive protein, of MCP-1, and the monocyte traffic, of IL-6, TNF-alfa, of S-VCAM-1, of COX-2 and MMP-9, and upregulate the TPA, and downregulate the PAI-1, statins also reduce the expression of CD40 on the endothelial surface, thus augmenting the EPC (endothelial progenitor cells) involved in neo-vascularization of ischemic tissue, with a final protective effects over the vascular endothelium, including the plaque stabilization.

We have studied 67 patients with a previous ischemic stroke aged between 58 and 72 years (25% smoker, 32% with hypertension, 14% with diabetes, 6% with obesity), with LDL-C higher than 130 mg/dl, evaluating in particular the lipidic profile (total cholesterol, HDL, LDL, TG, Lpa), fibrinogen and d-dimer for a total period of 36 months. We observed a clear reduction of lipidic parameters: Total-C <42%, LDL-C <46%, TG <30%, ApoB <35%, d-dimer <10%, and we did not observe any increase in transaminases, CPK, or fibrinogen.

We observed 12 patients with relapsing clinical events requiring emergency hospitalization: 1 exitus for second stroke two months after the first event, 11 cases of RIND, with less than 4 transitory ischemic episodes, with the total length of events significantly reduced after the first 18 weeks of treatment. We have observed 22 adverse effects events: 4 cases of epistaxis, 2 case of tooth bleeding, 3 of abdominal pain, 9 of muscular pain, 2 of chest pain, 2 case of headache, however, these events did not influence the course of the pharmacological treatment; 55 patients did not refer any clinical problem, every patient has been followed on the basis of a three months period, and on demand.

The present study has demonstrated a secure efficacy of the aggressive combined treatment (antiplatelet + statin) in the management of patients with a previous stroke, showing a symptomatologic benefit (reduction of the total ischemic events and of the emergencies) with an overall improvement of the quality of life.

PARAMETERBEFOREAFTER
TOTAL-C 320.0 mg/dl 180.0 mg/dl 
LDL-C 148.0 mg/dl 82.4 mg/dl 
HDL-C 38.6 mg/dl 44.2 mg/dl 
TG 180.0 mg/dl 108.2 mg/dl 
FIBRINOGEN 460.0 mg/dl 370.0 mg/dl 
FASTING GLUCOSE 110.0 mg/dl 96.0 mg/dl 
PARAMETERBEFOREAFTER
TOTAL-C 320.0 mg/dl 180.0 mg/dl 
LDL-C 148.0 mg/dl 82.4 mg/dl 
HDL-C 38.6 mg/dl 44.2 mg/dl 
TG 180.0 mg/dl 108.2 mg/dl 
FIBRINOGEN 460.0 mg/dl 370.0 mg/dl 
FASTING GLUCOSE 110.0 mg/dl 96.0 mg/dl 

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