The Effects Of Different Doses Of Atorvastatin On Severe Intra-Cranial Artery Stenosis Or Occlusion In Patients With Ischemic Cerebrovascular Disease

Objective: Cerebrovascular disease is one of the major diseases thatseverely threaten human life and health worldwide. Cerebrovascular diseasehas high morbidity and mortality. It often leads to severe sequela, such ashemiplegia, aphasia and so on. The morbidity of stroke tends to increase withthe age. Ahough giving patients possitive theatment, the recurrence rate ofcerebrovascular disease is still high. So it has great practical significance toprevent the recurrence of stoke. There are many reasons of stoke, and one ofimportant factors is intracranial atherosclerotic stenosis (IAS). The naturalcourse of IAS has the characteristics of progress and multiple-site, and it has ahigh risk of recurrence. Therefore, it may reduce the recurrence rate ofcerebrovascular disease through preventing the progression of atherosclersisplaque.The common risk factors of IAS include age, gender, smoking, diabetes,hypertension and hyperlipidemia and so on. The treatments of IAS containmedical, surgical and endovascular methods. The medical treatments of IASinclude application of antithrombotic drugs, lipid-modulating therapy andcontrolling risk factors. Statins is a inhibitor of3-hydroxy-3-methyl-glutaryl(HMG)-CoA reductase, it can effectively reduce the plasma cholesterol(TC)、triglycerides(TG)、low density lipoprotein(LDL) and mildly increase highdensity lipoprotein (HDL). At present, the study has proved atorvastatin notonly has the effect of reducing the blood lipids level, but also has the functionof anti-inflammation, improving endothelial funtion, promoting the stability ofthe plaques and so on. Some imaging trials show that statins can stabilize orreverse the carotid artery and coronary atherosclerosis, thus reducing the riskof cardiovascular and cerebrovascular events. The experiment explores the role of different doses of atorvastatin on adjusting lipids, applying magneticresonance angiography(MRA) to evaluate the influence of atorvastatin on thesevere intracranial artery stenosis or occlusion. We also observe the effect ofatorvastatin preventing the recurrence of ischemic cerebrovascular disease andevaluating the safety of atorvastatin.Method: All the patients in the neurology hospitalization and clinic ofthe second hospital of hebei medical university from May2012to March2013were included into the survey, a total of90cases. All patients were severeintracranial artery stenosis or occlusion with the examing by MRA. Thepatients were randomly divided into three groups, each containing30cases.Group A were given the conventional treatment of ischemic cerebrovasculardisease. Group B were given atorvastatin20mg every night on the basis ofconventional treatment. Group C were given atorvastatin10mg every night onthe basis of conventional treatment. Follow up of12months, the mainobservation indexes included blood lipid levels and Head MRA evaluationbefore and after the treatment. Safety indexes included liver function, renalfunction, blood routine, muscle enzymes, blood sugar and observed anyreactions including gastrointestinal symptoms, muscle pain, paresthesia, etc.Results:1Lipid analysis:Comparison in group: After treatment by1year, the TC, TG, LDL andHDL levels of Group A had no obvious change, the difference was notstatistically significant (P>0.05). Group B and Group C could obviouslyreduce the TC, TG, LDL levels comparing with that before threatment, thedifference was statistically significant(P<0.05), whereas no obvious change inHDL than before threatment(P>0.05).Comparison among three groups: Comparing among three groups ofpatients before treatment, there was no significant difference in TC, TG, LDLand HDL levels(P>0.05). After treatment by1year, there was significantdifference in TC, TG and LDL levels among three groups(P<0.05), but therewas no obvious difference in HDL levels(P>0.05). Comparing with Group A, Group B and Group C could significantly reduce the TC, TG, LDL levels, thedifference was statistically significant(P<0.05), but it had no significantdifference between the two groups(P>0.05).2Comparison of Head MRA results among three groups:After treatment by1year, it showed that there was statistically significantdifference in three groups(P<0.05). Then adjusting the inspection level α＇=α/3=0.0167, the results showed that comparing with Group A and Group C,Group B could significantly raise the improvement rate of IAS, the differencewas statistically significant(P<0.0167). There was no obvious differencebetween Group A and Group C(P<0.0167).3Comparison of recurrence rate of ICVD:After treatment by1year, the incidence of ICVD events was24.1%,0and3.6%in Group A, Group B and Group C, and there was no significantdifference in there groups(P<0.05). Then adjusting the inspection level α＇=0.0125, the results showed that comparing with Group A, Group B andGroup C could significantly reduce recurrence rate of ICVD, the differencewas statistically significant(P<0.0125), but it had no significant differencebetween the two groups(P>0.0125).4Safety evaluation of atorvastatin:The incidence of adverse events were6.9%,16.7%and10.3%in GroupA, Group B and Group C. One case withdrew from the study because of theincrease in transaminase>3times, one case because of the increase increatine kinase>5times and one case because of gastric intolerance. Therewas no statistically significant difference among three groups (P>0.05).Conclusion: For the patients of ischemic cerebrovascular disease withIAS, long-term oral atorvastatin can decrease blood lipid level, reduce therecurrence rate of ischemic cerebrovascular disease events, and adversereaction rate of atorvastatin is not significantly increased. We also canconclude that20mg of atorvastatin treatment group can prevent theprogression of intracranial atherosclerosis and even reverse plaques.Atorvastatin can be applied in clinical treatment.