- Home
- Medical news & Guidelines
- Anesthesiology
- Cardiology and CTVS
- Critical Care
- Dentistry
- Dermatology
- Diabetes and Endocrinology
- ENT
- Gastroenterology
- Medicine
- Nephrology
- Neurology
- Obstretics-Gynaecology
- Oncology
- Ophthalmology
- Orthopaedics
- Pediatrics-Neonatology
- Psychiatry
- Pulmonology
- Radiology
- Surgery
- Urology
- Laboratory Medicine
- Diet
- Nursing
- Paramedical
- Physiotherapy
- Health news
- Fact Check
- Bone Health Fact Check
- Brain Health Fact Check
- Cancer Related Fact Check
- Child Care Fact Check
- Dental and oral health fact check
- Diabetes and metabolic health fact check
- Diet and Nutrition Fact Check
- Eye and ENT Care Fact Check
- Fitness fact check
- Gut health fact check
- Heart health fact check
- Kidney health fact check
- Medical education fact check
- Men's health fact check
- Respiratory fact check
- Skin and hair care fact check
- Vaccine and Immunization fact check
- Women's health fact check
- AYUSH
- State News
- Andaman and Nicobar Islands
- Andhra Pradesh
- Arunachal Pradesh
- Assam
- Bihar
- Chandigarh
- Chattisgarh
- Dadra and Nagar Haveli
- Daman and Diu
- Delhi
- Goa
- Gujarat
- Haryana
- Himachal Pradesh
- Jammu & Kashmir
- Jharkhand
- Karnataka
- Kerala
- Ladakh
- Lakshadweep
- Madhya Pradesh
- Maharashtra
- Manipur
- Meghalaya
- Mizoram
- Nagaland
- Odisha
- Puducherry
- Punjab
- Rajasthan
- Sikkim
- Tamil Nadu
- Telangana
- Tripura
- Uttar Pradesh
- Uttrakhand
- West Bengal
- Medical Education
- Industry
Do Statins Reduce Risk of Stroke in Patients with MoyaMoya disease?
A receent article published in Stroke and Vascular Neurology sugests that in patients with Moya Moya disease (MMD), statin therapy is associated with a reduced risk of subsequent stroke. The findings indicate statin treatment may be beneficial for patients with MMD.
Moyamoya disease is a rare cerebrovascular disease characterised by progressive non-atherosclerotic steno-occlusive changes in the terminal portion of the bilateral internal carotid artery (ICA) and formation of abnormal vascular networks. As the disease progresses, patients with MMD are at increased risk of experiencing cerebrovascular complications of ischaemic and haemorrhagic stroke. For patients with MMD with severe haemodynamic impairment and repeated ischaemic symptoms, surgical revascularisation is considered the standard treatment to prevent future stroke but is not applicable to all patients.
Statins are widely prescribed lipid-lowering drugs shown to reduce the risk for cardiovascular disease, particularly due to atherosclerosis, such as ischaemic stroke or myocardial infarction. Based on extensive evidence, statin therapy is highly recommended as primary and secondary prevention for individuals with established atherosclerotic cardiovascular disease or subjects at high risk of developing atherosclerotic cardiovascular disease. Although MMD is a non-atherosclerotic vasculopathy, statins have multiple pleiotropic and vasculoprotective activities including endothelial protection, vascular remodelling, antithrombotic, anti-inflammatory, immunomodulatory and lipid-lowering effects. Inflammation and immune responses play an important role in the development and progression of MMD. Therefore, statins are considered potential candidates for medical treatment in MMD.
In this nationwide population-based cohort study conducted Yoo et al from South Korea with 13 373 newly diagnosed patients with MMD, statin treatment was associated with a lower incidence of stroke. Patients with MMD who received statin treatment were also at lower risk of all-cause mortality. Regardless of a concurrent stroke at the time of MMD diagnosis and revascularisation surgery, statinswere associated with a decreased risk of stroke.
In patients with MMD, various circulating proinflammatory molecules and angiogenetic factors are involved in the formation of moyamoya vessels by causing endothelial proliferation, intimal thickening, smooth muscle cell migration and matrix accumulation. Therefore, controlling the inflammatory and pathogenic cascade could be a possible target in the treatment of MMD. Experimental and clinical evidence has shown that statins exert various vasculoprotective effects on immunomodulatory, anti-inflammatory and antioxidant properties independent of their LDL-C-lowering effects. Statins increase the bioavailability of nitric oxide, promote re-endothelialisation, reduce oxidative stress and suppress CD40 expression and nuclear factor (NF)-κB activation, which inhibit the inflammatory response. Statins also modulate hypoxia-induced endothelial proliferation, formation of reactive oxygen species and the angiogenesis signalling pathway.
In the present study, statins were associated with a lower incidence of haemorrhagic stroke in patients with MMD who are at high risk of haemorrhagic stroke due to their vulnerable moyamoya vessels. In addition, haemorrhagic stroke occurred more frequently than ischaemic stroke. When rebleeding occurs in patients with MMD with prior haemorrhagic stroke, the prognosis is very poor. Statin therapy can inhibit the expression of the proinflammatory molecules which contribute to the reduction of haemorrhagic stroke, a critical complication in patients with MMD. The results of the present study indicate statins may protect against haemorrhagic stroke in patients with MMD, and statins can at least be used relatively safely in patients with MMD at increased risk of haemorrhagic stroke.
Although statins are not commonly used in patients with MMD, statins may be a useful treatment option for the prevention of stroke in patients with MMD. The potential effects of statins demonstrated in this study should be further confirmed in prospective studies, the authors suggest.
Reference
Yoo J, Jeon J, Baik M, et al Association between statin therapy and the risk of stroke in patients with moyamoya disease: a nationwide cohort study Stroke and Vascular Neurology 2023;8
doi: 10.1136/svn-2022-001985
MBBS, DrNB Neurosurgery
Krishna Shah, MBBS, DrNB Neurosurgery. She did her MBBS from GMC, Jamnagar, and there after did direct 6 Year DrNB Neurosurgery from Sir Ganga Ram Hospital, Delhi. Her interests lie in Brain and Spine surgery, Neurological disorders, minimally invasive surgeries, Endoscopic brain and spine procedures, as well as research.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751