Association between endothelial cell stabilizing medication and small vessel disease stroke: a case-control study

Becker, C. E., Quinn, T. J. and Williams, A. (2019) Association between endothelial cell stabilizing medication and small vessel disease stroke: a case-control study. Frontiers in Neurology, 10, 1029. (doi: 10.3389/fneur.2019.01029) (PMID:31608006) (PMCID:PMC6773869)

Abstract

Increasing evidence suggests a role for endothelial cell (EC) dysfunction in pathogenesis of cerebral small vessel disease. Commonly used medications including certain antihypertensives and statins have EC-stabilizing effects. We used individual patient data from completed acute stroke trials to assess whether prior exposure to EC-stabilizing medications was associated with lacunar stroke, using lacunar stroke as a clinical proxy for cerebral small vessel disease. Across 12,002 patients with relevant data, 2,855 (24%) had a lacunar stroke presentation. Univariable analyses suggested potential confounding from vascular diseases treated with EC-stabilizing medications. Initial multivariable logistic regression gave conflicting results when describing the independent association of exposure to EC-stabilizing medication and lacunar stroke in the complete population (O.R. 0.87, 95% C.I.: 0.77- 0.98) and limited to those taking any antihypertensive (O.R. 1.51, 95% C.I.: 1.21-1.88). Re-running the analyses including statins in the EC-stabilizing category suggested a beneficial effect of EC-stabilizing medication exposure on lacunar stroke incidence (O.R. 0.83, 95% C.I.: 0.73-0.93). These results align with recent pre-clinical data and would support interventional trials of EC-stabilizing medication for preventing cerebral small vessel disease. Our results also suggest that analyses of EC-stabilizing interventions need to adjust for potential endothelial effects of other co-prescribed medication.

• Item Type: Articles
• Additional Information: This study was supported by a joint Chief Scientist Office/Stroke Association senior lectureship to TQ and by the UK Dementia Research Institute (AW).
• Keywords: Anti-hypertensive, endothelial cell, lacunar, small vessel disease, statin, stroke.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Quinn, Professor Terry
• Authors: Becker, C. E., Quinn, T. J., and Williams, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Frontiers in Neurology
• Publisher: Frontiers Media
• ISSN: 1664-2295
• ISSN (Online): 1664-2295
• Copyright Holders: Copyright © 2019 Becker, Quinn and Williams
• First Published: First published in Frontiers in Neurology 10:1029
• Publisher Policy: Reproduced under a Creative Commons License