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Lowering C-reactive protein with statins after an ischemic stroke avoids mortality and readmissions. A prospective
José Carlos Arévalo-Lorido1, Juana Carretero-Gómez, José María Fernández-Recio
1Department of Internal Medicine Department, Zafra County Hospital , Zafra , Spain.
Insights
Statins significantly reduce mortality and readmissions in ischemic stroke patients. This benefit is linked to lowering both LDL-cholesterol and C-reactive protein (CRP) levels.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Statins possess pleiotropic effects beyond lipid-lowering.
- Ischemic stroke poses significant risks of mortality and readmission.
- The role of statins in mitigating post-stroke outcomes requires further investigation.
Purpose of the Study:
- To evaluate the impact of statin therapy on mortality and readmission rates in patients following an ischemic stroke.
- To determine if statins reduce these adverse events by modulating LDL-cholesterol and C-reactive protein (CRP) levels.
Main Methods:
- A prospective cohort study involving 359 ischemic stroke patients.
- Recording of pre-stroke and post-stroke medication regimens.
- Measurement of cholesterol and high-sensitivity C-reactive protein (hsCRP) levels at admission and 90 days.
- Assessment of Rankin score, fatality, and readmissions at 90 days and 1 year.
Main Results:
- Statin therapy, initiated pre-stroke or during hospitalization, was associated with reduced total mortality (OR 0.30) and cardiovascular mortality (OR 0.29).
- Statin use also correlated with improved overall mortality and readmission rates (OR 0.35).
- A decrease in hsCRP levels by 0.4 mg/dL was linked to a 30% reduction in mortality or readmissions.
Conclusions:
- Statin therapy, whether pre-existing or initiated early post-stroke, improves survival and reduces readmission rates.
- These benefits are potentially mediated by the combined effect of lowering cholesterol and hsCRP levels.
- Early statin initiation is a promising strategy for enhancing recovery and reducing long-term risks in ischemic stroke patients.
Aims:
A hypothetical benefit of statins after an ischemic stroke could be provided by their pleiotropic effects. Our aim is to test if statins are able to avoid mortality and readmissions of patients with ischemic stroke, by lowering their levels of not only LDL-cholesterol but also CRP.
Methods:
A prospective cohort study was performed. Pre-stroke and post-stroke medications were recorded. Cholesterol and hsCRP levels were measured at admission and 90 days post-stroke. Rankin score and fatality or readmissions were assessed at 90 days and 1 year. We have used robust statistical methods.
Results:
Of 359 stroke patients, statins were prescribed before stroke onset in 30.6% (110/359) and were begun during hospitalization in an additional 32.3% (116/359). In logistic regression analysis adjusted, statins therapy was independently associated with improved total mortality (OR 0.30; 95% CI 0.11-0.86; P < 0.02), improved cardiovascular mortality (OR 0.29; 95% CI 0.08-0.98; P < 0.04), and improved total mortality and readmission rates (OR 0.35; 95% CI 0.18-0.7; P < 0.003). In the final model, lowering the levels of hsCRP by 0.4mg/dL, a 30% of mortality or readmissions would be avoided.
Conclusions:
Therapy with statins, either previous or early initiation, after an ischemic stroke, could improve the survival and readmission rates by lowering both cholesterol and hsCRP levels.
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