Chudzik Wiesław, Kaczorowska Beata, Chmielewski Henryk, Przybyła Monika, Gałka Małgorzata
Klinika Neurologii i Neurorehabilitacji z Oddzialem Udarowym Uniwersyteckiego Szpitala Klinicznego nr 2 w Lodzi.
Pol Merkur Lekarski. 2005 Oct;19(112):591-5.
The occurrence of stroke increases with age, particularly affecting the older elderly, a population also at higher risk for coronary heart disease (CHD). Epidemiological and observational studies have not shown a clear association between cholesterol levels and all causes of stroke. Nevertheless, large, long-term statin trials in patients with established CHD or et high risk for CHD (diabetes, hypertension) have shown that statins decrease stroke incidence in these populations even with a normal baseline cholesterol concentration. In patients with previous stroke statins reduce the incidence of coronary events, but whether they actually reduce the incidence of recurrent strokes in secondary prevention is unproved. In this review we discuss the potential reason for the effects of statins on stroke and the mechanisms of action. Statins probably reduce stroke by a variety of mechanisms. Several studies indicate that statins have multiple effects beyond lowering the cholesterol level. There is evidence that statins have neuroprotective properties for the acute ischaemic brain. Statins interfere with platelet aggregation and have anti-inflammatory and antioxidative properties. Also statins promote stabilisation of atherosclerotic plaques and improve blood flow to the ischaemic brain. The protective effects of statins might be due to their direct effect on endothelial cells leading to improved nitric oxide (NO) bioavailability. However further studies are needed to understand the full role of statins in the prevention of stroke in patients without established cardiovascular disease, representative of the typical stroke population.
中风的发生率随年龄增长而增加，尤其影响高龄老年人，这一人群患冠心病（CHD）的风险也较高。流行病学和观察性研究并未表明胆固醇水平与所有中风病因之间存在明确关联。然而，针对已确诊冠心病或冠心病高危（糖尿病、高血压）患者的大型长期他汀类药物试验表明，即使基线胆固醇浓度正常，他汀类药物也能降低这些人群的中风发生率。对于既往有中风史的患者，他汀类药物可降低冠状动脉事件的发生率，但在二级预防中它们是否真的能降低复发性中风的发生率尚无定论。在本综述中，我们讨论了他汀类药物对中风产生影响的潜在原因及其作用机制。他汀类药物可能通过多种机制降低中风风险。多项研究表明，他汀类药物除了降低胆固醇水平外还有多种作用。有证据表明，他汀类药物对急性缺血性脑具有神经保护特性。他汀类药物可干扰血小板聚集，具有抗炎和抗氧化特性。此外，他汀类药物可促进动脉粥样硬化斑块的稳定，并改善缺血性脑的血流。他汀类药物的保护作用可能归因于其对内皮细胞的直接作用，从而提高一氧化氮（NO）的生物利用度。然而，对于他汀类药物在预防无心血管疾病患者（典型中风人群）中风方面的全面作用，仍需要进一步研究。
