Wang Jie, Weng Jiancong, Li Hao, Jiao Yuming, Fu Weilun, Huo Ran, Yan Zihan, Xu Hongyuan, Zhan Jiong, Wang Shuo, Du Xin, Cao Yong, Zhao Jizong
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Neuroscience Imaging Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Ther Adv Neurol Disord. 2021 Apr 9;14:1756286420987939. doi: 10.1177/1756286420987939. eCollection 2021.
The role of statins in unruptured intracranial aneurysm (UIA) growth and rupture remains ambiguous. This study sought to determine whether atorvastatin is associated with aneurysm growth and rupture in patients harboring UIA <7 mm.
This prospective, multicenter cohort study consecutively enrolled patients with concurrent UIA <7 mm and ischemic cerebrovascular disease from four hospitals between 2016 and 2019. Baseline and follow-up patient information was recorded. Because of the strong anti-inflammatory effect of aspirin, patients using aspirin were excluded. Patients taking atorvastatin 20 mg daily were atorvastatin users. The primary and exploratory endpoints were aneurysm rupture and growth, respectively.
Among the 1087 enrolled patients, 489 (45.0%) took atorvastatin, and 598 (55%) took no atorvastatin. After a mean follow-up duration of 33.0 ± 12.5 months, six (1.2%) and five (0.8%) aneurysms ruptured in atorvastatin and non-atorvastatin groups, respectively. In the adjusted multivariate Cox analysis, UIA sized 5 to <7 mm, current smoker, and uncontrolled hypertension were associated with aneurysm rupture, whereas atorvastatin [adjusted hazard ratio (HR) 1.495, 95% confidence interval (CI) 0.417-5.356, = 0.537] was not. Of 159 patients who had follow-up imaging, 34 (21.4%) took atorvastatin and 125 (78.6%) took no atorvastatin. Aneurysm growth occurred in five (14.7%) and 21 (16.8%) patients in atorvastatin and non-atorvastatin groups (mean follow-up: 20.2 ± 12.9 months), respectively. In the adjusted multivariate Cox analysis, UIAs sized 5 to <7 mm and uncontrolled hypertension were associated with a high growth rate; atorvastatin (adjusted HR 0.151, 95% CI 0.031-0.729, = 0.019) was associated with a reduced growth rate.
We conclude atorvastatin use is associated with a reduced risk of UIA growth, whereas atorvastatin is not associated with UIA rupture. The Clinic Benefit and Risk of Oral Aspirin for Unruptured Intracranial Aneurysm Combined With Cerebral Ischemia http://www.clinicaltrials.gov NCT02846259.
他汀类药物在未破裂颅内动脉瘤（UIA）生长和破裂中的作用仍不明确。本研究旨在确定阿托伐他汀与直径<7mm的UIA患者的动脉瘤生长和破裂是否相关。
这项前瞻性、多中心队列研究于2016年至2019年连续纳入了来自四家医院的同时患有直径<7mm的UIA和缺血性脑血管疾病的患者。记录了患者的基线和随访信息。由于阿司匹林具有强大的抗炎作用，使用阿司匹林的患者被排除。每天服用20mg阿托伐他汀的患者为阿托伐他汀使用者。主要终点和探索性终点分别为动脉瘤破裂和生长。
在1087名纳入的患者中，489名（45.0%）服用阿托伐他汀，598名（55%）未服用阿托伐他汀。平均随访33.0±12.5个月后，阿托伐他汀组和非阿托伐他汀组分别有6个（1.2%）和5个（0.8%）动脉瘤破裂。在调整后的多变量Cox分析中，直径5至<7mm的UIA、当前吸烟者和未控制的高血压与动脉瘤破裂相关，而阿托伐他汀[调整后的风险比（HR）1.495，95%置信区间（CI）0.417 - 5.356，P = 0.537]则无关。在159名进行了随访影像学检查的患者中，34名（21.4%）服用阿托伐他汀，125名（78.6%）未服用阿托伐他汀。阿托伐他汀组和非阿托伐他汀组分别有5名（14.7%）和21名（16.8%）患者出现动脉瘤生长（平均随访：20.2±12.9个月）。在调整后的多变量Cox分析中，直径5至<7mm的UIA和未控制的高血压与高生长率相关；阿托伐他汀（调整后的HR 0.151，95% CI 0.031 - 0.729，P = 0.019）与生长率降低相关。
我们得出结论，使用阿托伐他汀与UIA生长风险降低相关，而阿托伐他汀与UIA破裂无关。口服阿司匹林治疗未破裂颅内动脉瘤合并脑缺血的临床获益与风险 http://www.clinicaltrials.gov NCT02846259。
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