Statin Promotes Neurological Improvement in Acute Ischemic Stroke in Resource-limited Settings: A Cross-sectional Study of A Secondary Referral Center in Indonesia
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Abstract
Introduction: In limited resource settings where reperfusion therapy is inaccessible and unaffordable, identifying modifiable factors possibly mitigating neurological deficits is paramount. Statin is an affordable, widely available medication that has numerous pleiotropic effects beyond lipid-reducing, potentially beneficial in acute ischemic stroke. This study aims to evaluate factors associated with neurological improvement in acute ischemic stroke, particularly the role of statin, in a resource-limited setting. Methods: This study uses the stroke registry data from a secondary referral center in Indonesia between January 2023 until May 2024 and analyze the socio-demographic factors, onset-to-door time, past medical history, smoking, mean arterial pressure (MAP), body mass index (BMI), laboratory parameters, cardiac rhythm abnormality, chest X-ray results, non-contrast head computed tomography (NCCT) results, and therapy (oxygen supplementation, antihypertensive, antidiabetic medication, statins, dual antiplatelet therapy [DAPT], anticoagulant, and neuroprotector). Results: The majority of participants had minor (42.3%) and moderate stroke (42.3%) on admission. Fifty percent of the participants had neurological improvement on discharge. Multivariate analysis revealed a significant association between statin and neurological improvement in acute ischemic stroke, regardless of the lipid profile or duration of hospitalization. This finding highlighted possible mechanisms of statin other than cholesterol-lowering effects in improving neurological deficits. Conclusion: Statin use is significantly associated with neurological improvement in acute ischemic stroke, irrespective of cholesterol status. In resource-limited settings where definitive management is not an option, statin is a promising, readily available agent that promotes neurological improvement.
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