Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People's Republic of China.
Neurotherapeutics. 2014 Jul;11(3):606-11. doi: 10.1007/s13311-014-0270-5.
Cerebral white matter hyperintensities (WMH) are a consequence of cerebral small vessel disease. Statins have been shown to reduce recurrent stroke among patients with various stroke subtypes, including lacunar stroke, which also arises from small vessel disease. In this study, we investigated the hypothesis that prestroke statin use would reduce the progression of WMH and/or cognitive decline among stroke patients with confluent WMH. Patients (n = 100) were participants of the VITAmins To Prevent Stroke magnetic resonance imaging substudy. All patients had confluent WMH on magnetic resonance imaging at baseline. Eighty-one patients completed the 2-year follow-up. We assessed general cognition and executive function using the mini-mental state examination and Mattis dementia rating scale-initiation/perseveration subscale, respectively. We compared the change in volume of WMH and cognition between prestroke statin use and prestroke nonstatin use groups. We also evaluated the effects of prestroke statin use on incident lacunes and microbleeds. The prestroke statin use group (n = 51) had less WMH volume progression (1.54 ± 4.52 cm(3) vs 5.01 ± 6.00 cm(3), p = 0.02) compared with the prestroke nonstatin use group (n = 30). Multivariate linear regression modeling identified prestroke statin use as an independent predictor of WMH progression (β = -0.31, p = 0.008). Prestroke statin use was also associated with less decline (Mattis dementia rating scale-initiation/perseveration subscale; β = 0.47, p = 0.001). No association was observed with changes in mini-mental state examination scores. There were no between group differences on incident lacunes or incident microbleeds. Prestroke statin use may reduce WMH progression and decline in executive function in stroke patients with confluent WMH.
脑白质高信号（WMH）是脑小血管疾病的后果。他汀类药物已被证明可降低各种卒中亚型患者（包括腔隙性卒中，腔隙性卒中也源于小血管疾病）的复发性卒中。在这项研究中，我们假设在存在广泛 WMH 的卒中患者中，卒中前使用他汀类药物可减少 WMH 的进展和/或认知下降。患者（n=100）是 VITAmins To Prevent Stroke 磁共振成像子研究的参与者。所有患者在基线时磁共振成像上均存在广泛的 WMH。81 名患者完成了 2 年的随访。我们使用简易精神状态检查和 Mattis 痴呆评定量表的启动/持续子量表分别评估一般认知和执行功能。我们比较了卒中前使用他汀类药物与卒中前不使用他汀类药物组之间 WMH 体积变化和认知变化。我们还评估了卒中前使用他汀类药物对新发腔隙性梗死和微出血的影响。卒中前使用他汀类药物组（n=51）WMH 体积进展较少（1.54±4.52cm3 与 5.01±6.00cm3，p=0.02），与卒中前未使用他汀类药物组（n=30）相比。多元线性回归模型确定卒中前使用他汀类药物是 WMH 进展的独立预测因素（β=-0.31，p=0.008）。卒中前使用他汀类药物也与认知下降相关（Mattis 痴呆评定量表的启动/持续子量表；β=0.47，p=0.001）。与简易精神状态检查评分的变化无相关性。两组间新发腔隙性梗死或新发微出血无差异。在存在广泛 WMH 的卒中患者中，卒中前使用他汀类药物可能会减少 WMH 的进展和执行功能的下降。
