Katsanos A H, Lioutas V-A, Charidimou A, Catanese L, Ng K K H, Perera K, de Sa Boasquevisque D, Tsivgoulis G, Smith E E, Sharma M, Selim M H, Shoamanesh A
Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada.
Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Eur J Neurol. 2020 Jun;27(6):1023-1027. doi: 10.1111/ene.14196. Epub 2020 Mar 23.
Prevention of ischaemic stroke and cardiovascular events is an established benefit of statin therapy, but the effects of statin treatment on the accrual of magnetic resonance imaging (MRI) markers of ischaemic cerebral injury remain unknown. A systematic review was performed to identify all studies that randomized patients with cardiovascular risk factors to statin treatment and assessed the effect of statin treatment on covert infarcts (asymptomatic, evident only on neuroimaging) and white matter hyperintensity (WMH) accrual on MRI.
A systematic review in MEDLINE and Scopus from inception to 23 October 2019 was performed. A random-effects model was used to calculate the pooled estimates of the crude risk ratios and standardized mean differences.
Data from three randomized controlled trials (1430 participants) were included evaluating the effect of rosuvastatin (10 mg/day) in 668 hypertensive patients older than 60 years of age over 5 years, pravastatin (40 mg/day) in 554 elderly people more than 70 years of age over 3 years and simvastatin (20 mg/day) in 208 patients with asymptomatic middle cerebral artery stenosis over 2 years. Patients randomized to statin treatment had decreased accrual of new covert infarcts (risk ratio 0.63, 95% confidence interval 0.46-0.88) during a mean follow-up of 2-6 years. Only one study reported WMH decreased volume change in patients randomized to statin treatment compared to patients randomized to non-statin treatment (standardized mean difference -1.17; 95% confidence interval -1.33, -1.00).
Our findings suggest that, in addition to stroke prevention, statin treatment can reduce the accrual of covert MRI markers of ischaemic cerebral injury.
他汀类药物治疗已被证实具有预防缺血性卒中及心血管事件的益处，但他汀治疗对缺血性脑损伤磁共振成像（MRI）标志物累积的影响尚不清楚。我们进行了一项系统评价，以确定所有将有心血管危险因素的患者随机分组接受他汀治疗，并评估他汀治疗对隐匿性梗死（无症状，仅在神经影像学上可见）和MRI上白质高信号（WMH）累积影响的研究。
对MEDLINE和Scopus数据库从建库至2019年10月23日进行系统评价。采用随机效应模型计算粗风险比和标准化均数差的合并估计值。
纳入三项随机对照试验（1430名参与者）的数据，评估瑞舒伐他汀（10毫克/天）对668名60岁以上高血压患者5年的影响、普伐他汀（40毫克/天）对554名70岁以上老年人3年的影响以及辛伐他汀（20毫克/天）对208名无症状大脑中动脉狭窄患者2年的影响。在平均2至6年的随访期间，随机接受他汀治疗的患者新发隐匿性梗死的累积减少（风险比0.63，95%置信区间0.46 - 0.88）。只有一项研究报告，与随机接受非他汀治疗的患者相比，随机接受他汀治疗的患者WMH体积变化减少（标准化均数差 -1.17；95%置信区间 - –1.33，-1.00）。
我们的研究结果表明，除预防卒中外，他汀治疗还可减少缺血性脑损伤隐匿性MRI标志物的累积。
