Hypercholesterolemia: Leys D

Leys D, Kwiecinski H, Bogousslavsky J, Bath P, Brainin M, Diener HC, Kaste M, Sivenius J, Hennerici MG, Hacke W, Anonymous00185, Anonymous00186. · No affiliation provided · Cerebrovasc Dis. · Pubmed #14707404 No free full text.

This publication has no abstract.

Leys D, Deplanque D. · Research Groups on Cognitive Decline in Degenerative and Vascular Disorders (MENRT, EA 2691), University of Lille, Lille, France. · Therapie. · Pubmed #12822200 No free full text.

Abstract: An important issue for stroke prevention is the identification and treatment of risk factors such as hypercholesterolaemia. The 4 reasons to test if the statins have a role in stroke prevention are: (i) a statistical link between elevated low density lipoprotein-cholesterol or decreased high density lipoprotein-cholesterol and ischaemic stroke; (ii) a reduction in vascular risk with statins in randomised trials in patients with coronary heart disease; (iii) evidence of a decreased plaque progression under statins; and (iv) pooled analyses of primary and secondary prevention trials showing that reduction of total serum cholesterol reduces the incidence of stroke, especially with the highest rate of cholesterol reduction, and in patients with the highest risk of stroke (i.e. with statins in secondary prevention trials). The question of whether statins also have a neuroprotective effect in humans and reduce the risk of post-stroke dementia remains unsettled.

Leys D, Deplanque D, Lucas C, Bordet R. · · Clin Exp Hypertens. · Pubmed #12450233 No free full text.

Abstract: An important issue for stroke prevention is identification and treatment of risk factors such as hypercholesterolemia. The four reasons to test hypolipidemic agents in stroke prevention are: (i) a statistical link between elevated low-density lipoprotein cholesterol (LDL-c) or decreased high-density lipoprotein cholesterol (HDL-c) and ischemic stroke; (ii) a reduction in vascular risk in randomized trials in patients with coronary heart disease; (iii) evidence of a decreased plaque progression under statins, (iv) pooled analyses of primary and secondary prevention trials showing that reduction of total serum cholesterol reduces the incidence of stroke, especially with the highest rate of cholesterol reduction, and in patients with the highest risk of stroke (i.e., with statins in secondary prevention trials), and (v) prophylactic neuroprotection induced by hypolipidemic agents in animal models of cerebral ischemia. Data provided by trials conducted in subjects with coronary heart disease and in asymptomatic individuals should now be confirmed in stroke patient.

Leys D, Deplanque D, Mounier-Vehier C, Mackowiak-Cordoliani MA, Lucas C, Bordet R. · Department of Neurology, Stroke department, Roger Salengro Hospital, 59037 Lille, France. · J Neurol. · Pubmed #12021938 No free full text.

Abstract: Stroke prevention is a crucial issue because (i) stroke is a frequent and severe disorder, and (ii) acute stroke therapies that are effective at the individual level have only a little impact in term of public health. Stroke prevention consists of the combination of 3 strategies: an optimal management of vascular risk factors, associated when appropriate with antithrombotic therapies, carotid surgery, or both. Primary prevention trials have shown that reducing blood pressure in hypertensive subjects reduces their vascular risk, including stroke. The association of perindopril plus indapamide reduces the vascular risk in patients who have had a stroke or TIA during the last 5 years, irrespective of their baseline blood pressure. Lowering serum cholesterol with statins or gemfibrozil in patients with hypercholesterolemia or coronary heart disease (CHD), reduces the risk of stroke. However, no trial of cholesterol-lowering therapy has been completed in stroke patients. A strict control of high cholesterol levels should be encouraged, because of benefits in terms of CHD. Statins should be prescribed for stroke patients with CHD, or increased cholesterol levels. Cigarette smoking is associated with an increased risk of stroke and should be avoided. Careful control of all risk factors, especially arterial hypertension in type 1 and type 2 diabetics is recommended, together with a strict glycemic control to reduce systemic microvascular complications. Estrogens prescribed in hormone replacement or oral contraceptive therapies are not recommended after an ischemic stroke. It is also recommended to reduce alcohol consumption and obesity, and to increase physical activity in patients at risk for first-ever or recurrent stroke. An optimal management of risk factors for stroke is crucial to reduce the risks of first-ever stroke, recurrent stroke, any vascular event after stroke and vascular death. One of the major public health issues for the coming years will be to focus more on risk factor recognition and management.

Leys D. · Stroke Department, Lille University Hospital, France. · Vasc Med. · Pubmed #11789962 No free full text.

Abstract: Patients with peripheral arterial disease (PAD) have an increased risk of cerebral ischaemia, but many transient ischaemic attacks are not recognized by patients, or by physicians who are not neurologists. Similarly, PAD is common in stroke patients, but often remains unrecognized by neurologists. Major long-term risks in patients with cerebral ischaemia due to atherosclerosis are myocardial infarction and recurrence of stroke. Neurologists should consider concomitant PAD when choosing a treatment strategy. Patients with PAD need to be educated about their risk for cerebral ischaemic events, and physicians caring for PAD patients need to identify those individuals who may require carotid surgery. The appropriate strategy for prevention of stroke in PAD patients consists of optimal management of risk factors for stroke (smoking, arterial hypertension, hypercholesterolaemia), antiplatelet therapy with clopidogrel as first-choice treatment, and carotid surgery in patients with high-grade stenosis of the internal carotid artery who are at low risk for surgery.

Cordonnier C, Rutgers MP, Dumont F, Pasquini M, Lejeune JP, Garrigue D, Béjot Y, Leclerc X, Giroud M, Leys D, Hénon H. · Dept. of Neurology, Stroke Department, Lille University Hospital, 59037 Lille, France. · J Neurol. · Pubmed #19271106 No free full text.

Abstract: A better understanding of the natural history of intracerebral haemorrhages (ICH) with cohorts representing the whole spectrum of the disease is necessary to improve treatment. Our aim was to identify potential differences in baseline characteristics and short-term outcomes of patients with non-traumatic ICH, included in a hospital- and in a population-based stroke registry. We compared 373 patients recruited in a university hospital and the last 373 ICH patients included in a population-based registry. Both cohorts included consecutive patients with non-traumatic parenchymal haemorrhages. In the hospital cohort, we collected data from all patients admitted in the emergency room, irrespective of the clinical severity and of the specialist in charge of the patient.In the hospital cohort, patients were younger and more often alcoholic, but these differences may be explained by the younger age and a higher prevalence of alcoholism in this area. Patients also had more frequently hypercholesterolemia, and were more often under antiplatelet therapy. Both cohorts did not differ for intra-hospital casefatality rate.The characteristics of patients included in the hospital cohort were very close to those of patients from a population-based registry, and the differences observed are likely to be explained by differences in the characteristics of the populations in the two areas and different periods of recruitment. Recruiting patients in emergency rooms, and not in stroke units, neurological, or neurosurgical departments, has enabled us to build a cohort of ICH patients representative of the whole spectrum of the disease, with minimised recruitment bias and maximised precision of the variables collected. This cohort may, therefore, provide reliable information on the natural history of ICH.

Girot M, Mackowiak-Cordoliani MA, Deplanque D, Hénon H, Lucas C, Leys D. · Department of Neurology, Stroke Department, University of Lille Roger Salengro Hospital, 59037 Lille, France. · J Neurol. · Pubmed #15654550 No free full text.

Abstract: BACKGROUND AND OBJECTIVE: An optimal management of vascular risk factors, associated with antithrombotic drugs and carotid surgery when appropriate, reduces the risk of a new vascular event after stroke. Although secondary prevention is not optimal in many patients in practice, the question of whether there is an improvement over time remains unanswered. The aim of our study was to test the hypothesis that secondary prevention measures after cerebral ischemia improve over time. METHOD: We included 123 consecutive patients in 1994, and 125 consecutive patients in 2002, who were admitted to a neurological department for any reason and had had an episode of cerebral ischemia less than 6 years earlier. We compared the groups for the management of arterial hypertension, hypercholesterolemia, diabetes mellitus and smoking. We recorded the values of blood pressure, biological parameters, and presence of antithrombotic therapy, lipid-lowering and anti-hypertensive drugs. Whether patients were properly treated or not, was determined by a comparison between their current treatment and guidelines available when recruited. RESULTS: Prevention was not optimal in 96 of 123 (78%) patients in 1994, and in 77 of 125 (62 %) in 2002.Vascular risk factors were better identified and managed in 2002 than in 1994, especially for hypercholesterolemia. Antithrombotic therapies, statins and antihypertensive drugs, except calcium channel blockers, were more often used in 2002. The proportion of patients in whom arterial hypertension and hypercholesterolemia were identified was higher in 2002, but the proportion of patients identified as diabetics remained stable. However, the proportion of patients with blood pressure >140/90 mmHg, glycemia >or = 126 mg/dl, total cholesterol level > or = 240 mg/dl, or being current smokers, were significantly lower in 2002 than in 1994. CONCLUSION : Although most of patients with previous cerebral ischemia did not receive an optimal management of their risk factors in 2002, there was an improvement over an 8-year period.

Girot M, Deplanque D, Pasquier F, Destée A, Leys D. · Department of Neurology, University of Lille, Roger Salengro Hospital, 59037, Lille, France. · J Neurol. · Pubmed #15164184 No free full text.

Abstract: BACKGROUND: Secondary prevention measures in patients with cerebral ischemia or coronary heart disease (CHD) consist of vascular risk factors management and antithrombotic therapy. The aim of this study was to compare how secondary prevention measures are applied in practice between patients with a history of CHD or cerebral ischemia. METHOD: We compared vascular risk factors management and antithrombotic therapy between patients with a history of CHD and patients with a history of cerebral ischemia that occurred 2 months to 6 years earlier. Whether patients were properly treated or not was determined by a comparison between their current treatments and European guidelines for stroke and CHD management. RESULTS: We included 107 consecutive patients with a history of cerebral ischemia and 85 consecutive patients with a history of CHD. We found that: (i). most patients did not receive an appropriate secondary prevention in both groups: 76 of 107 patients with previous cerebral ischemia (71 %) and 73 of 85 patients with CHD (85.9 %); (ii). identification of risk factors, such as hypercholesterolemia, diabetes mellitus and smoking, did not differ between both groups, but arterial hypertension was more frequent in CHD patients; (iii). an inappropriate management of risk factors was more frequent in patients with TIA vs. ischemic stroke, and angina pectoris vs. myocardial infarction; (iv). arterial hypertension and hypercholesterolemia were the 2 more frequent risk factors that were not properly treated; (v). more than half diabetic patients had hyperglycemia > or= 126 mg/dl in both groups; (vi). patients with previous CHD had twice more frequently stopped smoking than those with cerebral ischemia. CONCLUSION: Many patients were not properly treated in both groups, and differences between practice and guidelines were more frequent in the CHD group, where guidelines are more strict.