Cerebrovascularis betegekben gyakoriak a haemorrheologiai és haemostaseologiai paraméterek kóros eltérései. A statinok az ischaemiás stroke prevenciójában hatékonyan alkalmazható szerek, kedvező hatásuk hátterében a lipidszint csökkentése mellett egyéb tényezők is igazolhatók. Célok: Tanulmányukban a szerzők áttekintik az atorvastatin stroke-prevencióval, haemorrheologiai és haemostaseologiai hatásaival kapcsolatos irodalmi adatokat, hivatkozva egy korábbi vizsgálatuk eredményeire, mely kis dózisú atorvastatinkezelés rövid távú haemorrheologiai, valamint endothel-diszfunkcióra és a thrombocytaaggregációra gyakorolt effektusait vizsgálta. Módszerek: 27 krónikus, hyperlipidaemiás agyérbetegnél (átlagéletkor: 61 ± 8 év) meghatározták a szérumlipidszinteket, a haemorrheologiai paramétereket (haematocrit, plazmafibrinogén-koncentráció, plazma- és teljesvér-viszkozitás, vörösvértest-aggregáció és -deformabilitás), a thrombocytaaggregációt kiinduláskor, majd 1 és 3 hónappal napi 10 mg atorvastatinkezelést követően. Az endothel-diszfunkciót jelző von Willebrand-faktor aktivitását a kezelés előtt, majd 1 hónap múlva mérték meg. Eredmények: A plazmakoleszterin-szint átlagos csökkenése 1, illetve 3 hónap múlva egyaránt 28% volt ( p < 0,001), az LDL-koleszterin-szint 40%-kal, illetve 38%-kal ( p < 0,001) csökkent a kiindulási értékhez képest. Az atorvastatinkezelés a teljesvér-viszkozitást a 3. hónap végére, míg a vvt-deformabilitást már az első hónap végére szignifikánsan csökkentette ( p < 0,05). A kollagén indukálta thrombocytaaggregáció a kiindulási értékhez képest szignifikánsan csökkent ( p < 0,001) változatlan antiaggregációs kezelés mellett. Szintén szignifikánsan javult a von Willebrand-faktor-aktivitás már 1 hónapos kezelést követően ( p < 0,05). Következtetések: Mind az irodalmi, mind a szerzők saját eredményei az atorvastatin komplex, kedvező hatására utalnak. A lipidcsökkentő effektus mellett a kis dózisban és rövid ideig alkalmazott atorvastatin javítja a haemorrheologiai paramétereket, a thrombocytaaggregációt és az endothel-diszfunkciót.
Józan P.: Az agyérbetegségek halandóságának néhány fontosabb jellemzője. Agyérbetegségek, 1998, IV , 2–6.
Józan P. , 'Az agyérbetegségek halandóságának néhány fontosabb jellemzője ' (1998 ) IV Agyérbetegségek : 2 -6 .
Bonita, R.: Epidemiology of stroke. Lancet, 1992, 339 , 342–344.
Bonita R. , 'Epidemiology of stroke ' (1992 ) 339 Lancet : 342 -344 .
Leonhardt, H., Arntz, H. R., Klemens, U. H.: Studies of plasma viscosity in primary hyperlipoproteinaemia. Atherosclerosis, 1977, 28 , 29–40.
Klemens U. H. , 'Studies of plasma viscosity in primary hyperlipoproteinaemia ' (1977 ) 28 Atherosclerosis : 29 -40 .
Callahan, A.: Cerebrovascular disease and statins: a potential addition to the therapeutic armamentarium for stroke prevention. Am. J. Cardiol., 2001, 88 , 33J–37J.
Callahan A. , 'Cerebrovascular disease and statins: a potential addition to the therapeutic armamentarium for stroke prevention ' (2001 ) 88 Am. J. Cardiol. : 33J -37J .
Prospective Studies Collaboration: Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts. Lancet, 1995, 346 , 1647–1653.
'Cholesterol, diastolic blood pressure, and stroke: 13 000 strokes in 450 000 people in 45 prospective cohorts ' (1995 ) 346 Lancet : 1647 -1653 .
Hebert, P. R., Gaziano, J. M., Chan, K. S. és mtsai: Cholesterol lowering with statin drugs, risk of stroke, and total mortality. JAMA, 1997, 278 , 313–321.
Chan K. S. , 'Cholesterol lowering with statin drugs, risk of stroke, and total mortality ' (1997 ) 278 JAMA : 313 -321 .
Amarenco, P., Labreuche, J., Lavallée, P. és mtsai: Statin in stroke prevention and carotid atherosclerosis. Systematic review and up-to-date meta-analysis. Stroke, 2004, 35 , 2902–2909.
Lavallée P. , 'Statin in stroke prevention and carotid atherosclerosis. Systematic review and up-to-date meta-analysis ' (2004 ) 35 Stroke : 2902 -2909 .
Amarenco, P.: Hypercholesterolemia, lipid lowering agent and the risk of brain infarction. Neurology, 2001, 57 , S35–S44.
Amarenco P. , 'Hypercholesterolemia, lipid lowering agent and the risk of brain infarction ' (2001 ) 57 Neurology : S35 -S44 .
Fisher, M., Herbert, J., Meiselman, J.: Hemorheological factors in cerebral ischemia. Stroke, 1991, 22 , 1164–1169.
Meiselman J. , 'Hemorheological factors in cerebral ischemia ' (1991 ) 22 Stroke : 1164 -1169 .
Koenig, W., Ernst, E.: The possible role of hemorheology in atherothrombogenesis. Atherosclerosis, 1992, 94 , 9–107.
Ernst E. , 'The possible role of hemorheology in atherothrombogenesis ' (1992 ) 94 Atherosclerosis : 9 -107 .
Fisher, M., Herbert, J., Meiselman, J.: Hemorheological factors in cerebral ischemia. Stroke, 1991, 22 , 1164–1169.
Meiselman J. , 'Hemorheological factors in cerebral ischemia ' (1991 ) 22 Stroke : 1164 -1169 .
Ernst, E., Resch, K. L., Matrai, A. és mtsai: Impaired blood rheology: risk factor after stroke? J. Intern. Med., 1991, 229 , 457–462.
Matrai A. , 'Impaired blood rheology: risk factor after stroke? ' (1991 ) 229 J. Intern. Med. : 457 -462 .
Ernst, E.: Fibrinogen: Its emerging role as a cardiovascular risk factor. Angiology, 1994, 45 , 87–93.
Ernst E. , 'Fibrinogen: Its emerging role as a cardiovascular risk factor ' (1994 ) 45 Angiology : 87 -93 .
Otto, C., Ritter, M. M., Richter, W. O. és mtsai: Hemorheologic abnormalities in defined primary dyslipoproteinemias with both high and low atherosclerotic risks. Metabolism, 2001, 50 , 989–990.
Richter W. O. , 'Hemorheologic abnormalities in defined primary dyslipoproteinemias with both high and low atherosclerotic risks ' (2001 ) 50 Metabolism : 989 -990 .
Seplowitz, A. H., Chien, S., Smith, F. R.: Effects of lipoproteins on plasma viscosity. Atherosclerosis, 1981, 38 , 89–95.
Smith F. R. , 'Effects of lipoproteins on plasma viscosity ' (1981 ) 38 Atherosclerosis : 89 -95 .
Rosenson, R. S., Lowe, G. D. O.: Effects of lipids and lipoproteins on thrombosis and rheology. Atherosclerosis, 1988, 140 , 271–280.
Lowe G. D. O. , 'Effects of lipids and lipoproteins on thrombosis and rheology ' (1988 ) 140 Atherosclerosis : 271 -280 .
Fuster, V., Badimon, L., Badimon, J. J. és mtsai: The pathogenesis of coronary artery disease and the acute coronary syndromes. New Engl. J. Med., 1992, 326 , 242–250.
Badimon J. J. , 'The pathogenesis of coronary artery disease and the acute coronary syndromes ' (1992 ) 326 New Engl. J. Med. : 242 -250 .
Boda Z.: A haemostasis tényezői. In: Klinikai hemosztazeológia. Szerk.: Boda Z., Rák K., Udvardy M. Springer Tudományos Kiadó Kft., Budapest, 2000, 22–40.
Boda Z. , '', in Klinikai hemosztazeológia , (2000 ) -.
Bérczi V.: Atherosclerosis és szervi manifestatioi. In: Kardiológia 2000. Szerk.: Temesváry A., Gyenes G. Melania Kft., Budapest, 2000, 85–106.
Bérczi V. , '', in Kardiológia 2000 , (2000 ) -.
Blann, A. D., McCollum, C. N.: von Willebrand factor, endothelial cell damage and atherosclerosis. Eur. J. Vasc. Surg., 1994, 8 , 10–15.
McCollum C. N. , 'von Willebrand factor, endothelial cell damage and atherosclerosis ' (1994 ) 8 Eur. J. Vasc. Surg. : 10 -15 .
Zeiher, A. M., Drexler, H., Saurbier, B. és mtsai: Endothelium-mediated coronary flow modulation in humans: effects of age, atherosclerosis, hypercholesterolemia, and hypertension. J. Clin. Invest., 1993, 92 , 652–662.
Saurbier B. , 'Endothelium-mediated coronary flow modulation in humans: effects of age, atherosclerosis, hypercholesterolemia, and hypertension ' (1993 ) 92 J. Clin. Invest. : 652 -662 .
Wassmann, S., Laufs, U., Baumer, A. T. és mtsai: HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species. Hypertension, 2001, 37 , 1450–1457.
Baumer A. T. , 'HMG-CoA reductase inhibitors improve endothelial dysfunction in normocholesterolemic hypertension via reduced production of reactive oxygen species ' (2001 ) 37 Hypertension : 1450 -1457 .
Shiomi, M., Ito, T., Tsukada, T. és mtsai: Reduction of serum cholesterol levels alters lesional composition of atherosclerotic plaques: effect of pravastatin sodium on atherosclerosis in mature WHHL rabbits. Arterioscler. Thromb. Vasc. Biol., 1995, 15 , 1938–1944.
Tsukada T. , 'Reduction of serum cholesterol levels alters lesional composition of atherosclerotic plaques: effect of pravastatin sodium on atherosclerosis in mature WHHL rabbits ' (1995 ) 15 Arterioscler. Thromb. Vasc. Biol. : 1938 -1944 .
Szapary L., Horvath B., Marton Zs. és mtsai: Short term effect of low dose atorvastatin on hemorheological parameters, platelet aggregation and endothelial dysfunction in cerebrovascular patients with hyperlipidemia. CNS Drugs, 2004, 18 , 165–172.
Marton Zs. , 'Short term effect of low dose atorvastatin on hemorheological parameters, platelet aggregation and endothelial dysfunction in cerebrovascular patients with hyperlipidemia ' (2004 ) 18 CNS Drugs : 165 -172 .
Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evalution, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA, 2001, 285, 2486–2497.
Friedewald, W. T., Levy, R. I., Fredrickson, D. S.: Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin. Chem., 1972, 18 , 499–502.
Fredrickson D. S. , 'Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge ' (1972 ) 18 Clin. Chem. : 499 -502 .
Clauss, A.: Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens. Acta Haematol., 1957, 17 , 237–246.
Clauss A. , 'Gerinnungsphysiologische Schnellmethode zur Bestimmung des Fibrinogens ' (1957 ) 17 Acta Haematol. : 237 -246 .
Klose, H. J., Volger, E., Brechtelsbauer, H. és mtsai: Microrheology and light transmission of blood. Pflugers Arch., 1972, 333 , 126–139.
Brechtelsbauer H. , 'Microrheology and light transmission of blood ' (1972 ) 333 Pflugers Arch. : 126 -139 .
Goodall, A. H., Jarvis, J., Chand, S. és mtsai: An immunoradiometric assay for human factor VIII/von Willebrand factor (VIII: vWf) using monoclonal antibody that defines a functional epitope. Br. J. Hematol., 1985, 59 , 565–577.
Chand S. , 'An immunoradiometric assay for human factor VIII/von Willebrand factor (VIII: vWf) using monoclonal antibody that defines a functional epitope ' (1985 ) 59 Br. J. Hematol. : 565 -577 .
Elkind, M. S., Flint, A. C., Sciacca, R. R. és mtsai: Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality. Neurology, 2005, 65 , 253–258.
Sciacca R. R. , 'Lipid-lowering agent use at ischemic stroke onset is associated with decreased mortality ' (2005 ) 65 Neurology : 253 -258 .
Parra, A., Kreiter, K. T., Williams, S. és mtsai: Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage: a matched controlled cohort study. Neurosurgery, 2005, 56 , 476–484.
Williams S. , 'Effect of prior statin use on functional outcome and delayed vasospasm after acute aneurysmal subarachnoid hemorrhage: a matched controlled cohort study ' (2005 ) 56 Neurosurgery : 476 -484 .
Vaughan, C. J., Delanty, N.: Neuroprotective properties of statins in cerebral ischemia and stroke. Stroke, 1999, 30 , 1969–1973.
Delanty N. , 'Neuroprotective properties of statins in cerebral ischemia and stroke ' (1999 ) 30 Stroke : 1969 -1973 .
Rubins, H. B., Robins, S. J., Collins, D. és mtsai: Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol. N. Engl. J. Med., 1999, 341 , 410–418.
Collins D. , 'Gemfibrozil for the secondary prevention of coronary heart disease in men with low levels of high-density lipoprotein cholesterol ' (1999 ) 341 N. Engl. J. Med. : 410 -418 .
The BIP Study Group: Secondary prevention by raising HDL-cholesterol and reducing triglycerides in patienst with coronary artery disease. The Bezafibrate Infarction Prevention (BIP) Study. Circulation, 2000, 102 , 21–27.
'Secondary prevention by raising HDL-cholesterol and reducing triglycerides in patienst with coronary artery disease. The Bezafibrate Infarction Prevention (BIP) Study ' (2000 ) 102 Circulation : 21 -27 .
Davidson, M., McKenny, J., Stein, E. és mtsai, for the Atorvastatin Study Group I: Comparison of one year efficacy and safety of atorvastatin versus lovastatin in primary hypercholesterolaemia. Am. J. Cardiol., 1997, 79 , 1475–1481.
Stein E. , 'Comparison of one year efficacy and safety of atorvastatin versus lovastatin in primary hypercholesterolaemia ' (1997 ) 79 Am. J. Cardiol. : 1475 -1481 .
Nawrocki, J. W., Weiss, S. R., Davidson, M. H. és mtsai: Reduction of LDL-cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler. Thromb. Vasc. Biol., 1995, 15 , 678–682.
Davidson M. H. , 'Reduction of LDL-cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor ' (1995 ) 15 Arterioscler. Thromb. Vasc. Biol. : 678 -682 .
The SPARCL Investigators: The Stroke Prevention by Agressive Reduction in Cholesterol Levels (SPARCL) study. Cerebrovasc. Dis., 2006, 21 (Suppl. 4) , 1. Abstract 1.
'The Stroke Prevention by Agressive Reduction in Cholesterol Levels (SPARCL) study ' (2006 ) 21 Cerebrovasc. Dis. : 1 -.
LaRosa, J. C., Grundy, S. M., Waters, D. D. és mtsai: Treating to New Target (TNT) Investigators. Intensive lipid lowering with atorvastatin in the patients with stable coronary disease. N. Engl. J. Med., 2005, 352 , 1425–1435.
Waters D. D. , 'Treating to New Target (TNT) Investigators. Intensive lipid lowering with atorvastatin in the patients with stable coronary disease ' (2005 ) 352 N. Engl. J. Med. : 1425 -1435 .
Law, M. R., Wald, N. J., Rudnicka, A. R.: Quantifying effect of statins on low density lipoprotein cholesterol, ischemic heart disease, and stroke, systematic review and meta-analysis. BMJ, 2003, 326 , 1423–1427.
Rudnicka A. R. , 'Quantifying effect of statins on low density lipoprotein cholesterol, ischemic heart disease, and stroke, systematic review and meta-analysis ' (2003 ) 326 BMJ : 1423 -1427 .
Otto, C., Ritter, M. M., Richter, W. O. és mtsai: Hemorheologic abnormalities in defined primary dyslipoproteinemias with both high and low atherosclerotic risks. Metabolism, 2001, 50 , 989–990.
Richter W. O. , 'Hemorheologic abnormalities in defined primary dyslipoproteinemias with both high and low atherosclerotic risks ' (2001 ) 50 Metabolism : 989 -990 .
Vaya, A., Martinez, M., Dalmau, J. és mtsai: Hemorheological changes in children with polygenic hypercholesterolemia. Clin. Hemorheol. Microcirc., 1998, 19 , 250–262.
Dalmau J. , 'Hemorheological changes in children with polygenic hypercholesterolemia ' (1998 ) 19 Clin. Hemorheol. Microcirc. : 250 -262 .
Czopf L., Halmosi R., Kesmarky G. és mtsai: Lovastatin and nitrate therapy induced changes in hemorheological parameters and in free radical mediated processes in patients with ischemic heart disease. Perfusion, 1999, 12 , 50–58.
Kesmarky G. , 'Lovastatin and nitrate therapy induced changes in hemorheological parameters and in free radical mediated processes in patients with ischemic heart disease ' (1999 ) 12 Perfusion : 50 -58 .
Wierzbicki, A. S., Lumb, P. J., Semra, Y. K. és mtsai: Effect of atorvastatin on plasma fibrinogen. Lancet, 1998, 351 , 569–570.
Semra Y. K. , 'Effect of atorvastatin on plasma fibrinogen ' (1998 ) 351 Lancet : 569 -570 .
Dujove, C. A., Harris, W. S., Altman, R. és mtsai: Effect of atorvastatin on hemorheologic-hemostatic parameters and serum fibrinogen levels in hyperlipidemic patients. Am. J. Cardiol., 2000, 85 , 350–353.
Altman R. , 'Effect of atorvastatin on hemorheologic-hemostatic parameters and serum fibrinogen levels in hyperlipidemic patients ' (2000 ) 85 Am. J. Cardiol. : 350 -353 .
Tsuda, Y., Satoh, K., Kitadai, M. és mtsai: Effects of pravastatin sodium and simvastatin on plasma fibrinogen and blood rheology in type II hypercholesterolaemia. Atherosclerosis, 1996, 22 , 225–233.
Kitadai M. , 'Effects of pravastatin sodium and simvastatin on plasma fibrinogen and blood rheology in type II hypercholesterolaemia ' (1996 ) 22 Atherosclerosis : 225 -233 .
Banyai S., Banyai M., Falger J. és mtsai: Atorvastatin improves blood rheology in patients with familial hypercholesterolemia (FH) on long-term apheresis treatment. Atherosclerosis, 2001, 159 , 513–519.
Falger J. , 'Atorvastatin improves blood rheology in patients with familial hypercholesterolemia (FH) on long-term apheresis treatment ' (2001 ) 159 Atherosclerosis : 513 -519 .
Galatius, S., Wroblewski, H., Sorensen, V. B. és mtsai: Endothelin and von Willebrand factor as parameters of endothelial function in idiopathic dilated cardiomyopathy: Different stimuli for release before and after heart transplantation? Am. Heart J., 1999, 137 , 549–554.
Sorensen V. B. , 'Endothelin and von Willebrand factor as parameters of endothelial function in idiopathic dilated cardiomyopathy: Different stimuli for release before and after heart transplantation? ' (1999 ) 137 Am. Heart J. : 549 -554 .
Smilde, T. J., Trip, M. D., Wollersheim, H. és mtsai: Rationale design and baseline characteristics of a clinical trial comparing the effects of robust vs convential cholesterol lowering and intima media thickness in patients with familial hypercholesterolemia: the Atorvastatin versus Simvastatin on Atherosclerosis Progression (ASAP) study. Clin. Drug Invest., 2000, 20 , 67–79.
Wollersheim H. , 'Rationale design and baseline characteristics of a clinical trial comparing the effects of robust vs convential cholesterol lowering and intima media thickness in patients with familial hypercholesterolemia: the Atorvastatin versus Simvastatin on Atherosclerosis Progression (ASAP) study ' (2000 ) 20 Clin. Drug Invest. : 67 -79 .