A Quantitative Study

Background:NewUSFoodandDrugAdministrationlabeling in 2003 recognizes stroke and evidence of cerebrovasculardiseaseasindicatorconditionsforinitiatingstatin (simvastatin) therapy, based on results of the Heart Protection Study, thereby extending the indications for statins in stroke beyond current US and European guidelines. Objective: To assess the impact on clinical practice of broadeningindicationsforstatinsinpatientswithstroke. Design: Observational study. Setting: University hospital stroke service. Patients: One hundred consecutive patients with ischemic stroke and transient ischemic attack. Interventions: Development and application of algorithmsforinitiatingstatintherapyinpatientswithstroke and transient ischemia abstracted from recent national and international guidelines (National Cholesterol EducationProgramAdultTreatmentPanelIII,EuropeanJoint TaskForceII),HeartProtectionStudyentrycriteria,and Heart Protection Study–based US Food and Drug Administration labeling. Main Outcome Measures:Percentages of patients who met clinical trial–validated and US Food and Drug Administration–approved criteria for initiation of statin therapy. Results: Patient age averaged 74 years (range, 35-96 years);64%werefemale,and74%werewhite.Strokesubtype was large-vessel atherosclerosis in 24%, cardioembolic in 44%, small-vessel atherosclerosis in 22%, and other in 10%. Twenty of 100 patients were already taking statins on admission. Guidelines for definite initiation of statin treatment were met by 48% of patients for theNationalCholesterolEducationProgramIII,38%for the European Joint Task Force II, 92% for the Heart Protection Study, and 100% for the Food and Drug Administration.

[1]  W. T. Peake,et al.  Middle-ear characteristics of anesthetized cats. , 1967, The Journal of the Acoustical Society of America.

[2]  D. J. Lim.  Tympanic membrane. II. Pars flaccida. , 1968, Acta oto-laryngologica.

[3]  D. Lim,et al.  Human tympanic membrane. An ultrastructural observation. , 1970, Acta oto-laryngologica.

[4]  James D. Miller.  Audibility curve of the chinchilla , 1970 .

[5]  B. M. Johnstone,et al.  Frequency Response of Bat Tympanic Membrane , 1972, Nature.

[6]  D. Lay.  The anatomy, physiology, functional significance and evolution of specialized hearing organs of gerbilline rodents , 1972, Journal of morphology.

[7]  B Salén,et al.  The role of the pars flaccida in the mechanics of the middle ear. , 1979, Acta oto-laryngologica.

[8]  Thomas J. Lynch.  Signal processing by the cat middle ear: admittance and transmission, measurements and models , 1981 .

[9]  E. Relkin,et al.  1 – The Structural and Functional Development of the Outer and Middle Ear1 , 1983 .

[10]  W. Funnell.  On the undamped natural frequencies and mode shapes of a finite-element model of the cat eardrum. , 1983, The Journal of the Acoustical Society of America.

[11]  D. Lim,et al.  Anatomy of the chinchilla bulla and eustachian tube: I. Gross and microscopic study. , 1987, American journal of otolaryngology.

[12]  Rondo E. Cameron.  A Concise Economic History of the World: From Paleolithic Times to the Present , 1989 .

[13]  L. Caplan.  Intracranial branch atheromatous disease , 1989, Neurology.

[14]  K. Asplund,et al.  Factors influencing admission blood pressure levels in patients with acute stroke. , 1991, Stroke.

[15]  C. Furberg,et al.  Effect of lovastatin on early carotid atherosclerosis and cardiovascular events. Asymptomatic Carotid Artery Progression Study (ACAPS) Research Group. , 1994, Circulation.

[16]  Education, globalization and catch-up: Scandinavia in the Swedish mirror , 1995 .

[17]  D. Clement.  A randomised, blinded, trial of Clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE) , 1996 .

[18]  M. Dennis.  A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). CAPRIE Steering Committee , 1996 .

[19]  B. Davis,et al.  The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. , 1996, The New England journal of medicine.

[20]  R. Westendorp,et al.  Stroke, statins, and cholesterol. A meta-analysis of randomized, placebo-controlled, double-blind trials with HMG-CoA reductase inhibitors. , 1997, Stroke.

[21]  David E. Hailey,et al.  Hypermedia, Multimedia, and Reader Cognition: An Empirical Study , 1998 .

[22]  R. Collins,et al.  Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. , 1998, The New England journal of medicine.

[23]  Trevor Grayling,et al.  Fear and Loathing of the Help Menu: A Usability Test of Online Help. , 1998 .

[24]  J. Papadakis,et al.  Lipids and stroke: neglect of a useful preventive measure? , 1998, Cardiovascular research.

[25]  David K. Farkas.  The Logical and Rhetorical Construction of Procedural Discourse , 1999 .

[26]  Jeffrey M. Wooldridge,et al.  Introductory Econometrics: A Modern Approach , 1999 .

[27]  S M Grundy,et al.  Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. , 1999, Circulation.

[28]  S. Ross,et al.  Clinical outcomes in statin treatment trials: a meta-analysis. , 1999, Archives of internal medicine.

[29]  E. Ferrari,et al.  Atherosclerosis of the thoracic aorta and aortic debris as a marker of poor prognosis: benefit of oral anticoagulants. , 1999, Journal of the American College of Cardiology.

[30]  J. Alger,et al.  Impact on stroke subtype diagnosis of early diffusion-weighted magnetic resonance imaging and magnetic resonance angiography. , 2000, Stroke.

[31]  A. Gawlinski,et al.  Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP). , 2001, The American journal of cardiology.

[32]  P. Sterzer,et al.  Pravastatin Improves Cerebral Vasomotor Reactivity in Patients With Subcortical Small-Vessel Disease , 2001, Stroke.

[33]  C. Hennekens.  Current perspectives on lipid lowering with statins to decrease risk of cardiovascular disease , 2001, Clinical Cardiology.

[34]  A. Gil-Núñez,et al.  Prevention of Brain Ischemia: Controversies and Perspectives , 2001 .

[35]  Valentin Fuster,et al.  Thrombus Formation on Atherosclerotic Plaques: Pathogenesis and Clinical Consequences , 2001, Annals of Internal Medicine.

[36]  S. Yusuf.  MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary , 2002 .

[37]  J. Corvol,et al.  Differential effects of lipid-lowering therapies on stroke prevention: a meta-analysis of randomized trials. , 2003, Archives of internal medicine.

[38]  J. Debatin,et al.  Detection of atherosclerosis: systemic imaging for systemic disease with whole-body three-dimensional MR angiography--initial experience. , 2003, Radiology.

[39]  R. Collins,et al.  Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial , 2003, The Lancet.

[40]  M. Müllner,et al.  Determination of Lipid Profiles and Use of Statins in Patients With Ischemic Stroke or Transient Ischemic Attack , 2003, Stroke.

[41]  M. Hennerici,et al.  Design and Baseline Characteristics of the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Study , 2003, Cerebrovascular Diseases.

[42]  J. Saver,et al.  PROTECT: A coordinated stroke treatment program to prevent recurrent thromboembolic events , 2004, Neurology.

[43]  J. Saunders,et al.  Auditory structure and function in the mouse middle ear: An evaluation by SEM and capacitive probe , 1982, Journal of comparative physiology.

[44]  S. Grundy,et al.  Clinical management of metabolic syndrome: report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association conference on scientific issues related to management. , 2004, Arteriosclerosis, thrombosis, and vascular biology.

[45]  D. Neumark-Sztainer,et al.  Psychosocial and behavioral correlates of dieting among overweight and non-overweight adolescents. , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[46]  D. Jacks.  What drove 19th century commodity market integration , 2006 .