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Thomas Nathaniel
University of South Carolina School of Medicine Greenville Campus
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0954-5050
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Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy.
Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions.
Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions.
Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.
Keywords
Cholesterol reducer, NIHSS score, Neurological deficits, Thrombolytic therapy, Ischemic stroke
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CURRENT STATUS: Published
View the published article at Lipids in Health and Disease.
Version 2
Posted 04 May, 2020
No community comments so far
Editorial decision: Accept
On 27 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Review #2 received
Received 25 Apr, 2020
Editor assigned
On 22 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Submission checks complete
On 21 Apr, 2020
Editor invited
On 21 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Apr, 2020
Review #3 received
Received 04 Apr, 2020
Reviewer #3 agreed
On 30 Mar, 2020
Review #1 received
Received 27 Mar, 2020
Review #2 received
Received 27 Mar, 2020
Reviewer #2 agreed
On 26 Mar, 2020
Reviewer #1 agreed
On 26 Mar, 2020
Reviewers invited
Invitations sent on 02 Feb, 2020
Editor assigned
On 09 Jan, 2020
Submission checks complete
On 08 Jan, 2020
Editor invited
On 08 Jan, 2020
First submitted
On 07 Jan, 2020
Metrics
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See the published version of this preprint at Lipids in Health and Disease.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Thomas Nathaniel
University of South Carolina School of Medicine Greenville Campus
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0954-5050
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Lipids in Health and Disease.
Version 2
Posted 04 May, 2020
No community comments so far
Editorial decision: Accept
On 27 Apr, 2020
Reviewer #2 agreed
On 25 Apr, 2020
Review #2 received
Received 25 Apr, 2020
Editor assigned
On 22 Apr, 2020
Reviewers invited
Invitations sent on 22 Apr, 2020
Reviewer #1 agreed
On 22 Apr, 2020
Review #1 received
Received 22 Apr, 2020
Submission checks complete
On 21 Apr, 2020
Editor invited
On 21 Apr, 2020
No comments provided
Editorial decision: Major revision
On 11 Apr, 2020
Review #3 received
Received 04 Apr, 2020
Reviewer #3 agreed
On 30 Mar, 2020
Review #1 received
Received 27 Mar, 2020
Review #2 received
Received 27 Mar, 2020
Reviewer #2 agreed
On 26 Mar, 2020
Reviewer #1 agreed
On 26 Mar, 2020
Reviewers invited
Invitations sent on 02 Feb, 2020
Editor assigned
On 09 Jan, 2020
Submission checks complete
On 08 Jan, 2020
Editor invited
On 08 Jan, 2020
First submitted
On 07 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Lipids in Health and Disease.
Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy.
Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions.
Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions.
Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
This is a list of supplementary files associated with this preprint. Click to download.
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