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Effects of Neuroprotectants Before and After Stroke: Statins and Anti-hypertensives

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Neuroprotective Therapy for Stroke and Ischemic Disease

Part of the book series: Springer Series in Translational Stroke Research ((SSTSR))

Abstract

Neuroprotection, as an anjunct or alternative therapy to thrombolysis, may be a rational strategy to improve penumbra survival. Nevertheless, so far none of the neuroprotectants found active in preclinical studies have been translated into clinical use.

The hypolipidaemic statins and the anti-hypertensive drugs are widely used as preventive treatments before and after stroke and whose neuroprotectant effects were demonstrated in experimental and some clinical studies.

Indeed, pleiotropic effects were reported on both cerebral endothelium (through the NO-induced vasodilation, and the anti-thrombotic, anti-oxidant and anti-inflammatory activities) and brain parenchyma (anti-excitotoxic, neurotrophic, anti-oxidant activities).

In this chapter we first describe the pharmacological activities of statins and various anti-hypertensive classes (drugs active on the RAS, CCBs, sympatholytics and diuretics), giving particular emphasis on their pleiotropic mechanisms. We then examine the evidence for their primary and secondary stroke-preventive activities. Overall, favourable effects were shown in non-thrombolyzed patients, though without clear differences among the four classes of anti-hypertensives. However, insufficient and inconclusive findings were reported in patients treated with thrombolysis, thus making more ad hoc experimental studies and RCTs highly recommended.

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Acknowledgements

The authors thank Ms. Giuliana Di Gregorio and Dr. Filippo Grandini for editing the chapter.

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

Funding

Italian Ministry for Education, University and Research (MIUR) and Investigator Fellowship by University College “Collegio Ghislieri”, Pavia, Italy, for Dr. Ferrari.

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Authors and Affiliations

  1. Laboratory of Pharmacology and Molecular Medicine of Central Nervous System, Department of Biology and Biotechnology, University of Pavia, Via Ferrata, 9, Pavia, 27100, Italy

    Roberto Federico Villa D.Sc., M.D., Ph.D., A.C.C.P., Federica Ferrari B.Sc., M.Sc., Ph.D., A.C.C.P. & Antonio Moretti D.Pharm., Ph.D.

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  1. Roberto Federico Villa D.Sc., M.D., Ph.D., A.C.C.P.
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  2. Federica Ferrari B.Sc., M.Sc., Ph.D., A.C.C.P.
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  3. Antonio Moretti D.Pharm., Ph.D.
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Correspondence to Roberto Federico Villa D.Sc., M.D., Ph.D., A.C.C.P. .

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Editors and Affiliations

  1. Department of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California, USA

    Paul A. Lapchak

  2. Loma Linda University School of Medicine, Loma Linda, California, USA

    John H. Zhang

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Villa, R.F., Ferrari, F., Moretti, A. (2017). Effects of Neuroprotectants Before and After Stroke: Statins and Anti-hypertensives. In: Lapchak, P., Zhang, J. (eds) Neuroprotective Therapy for Stroke and Ischemic Disease. Springer Series in Translational Stroke Research. Springer, Cham. https://doi.org/10.1007/978-3-319-45345-3_14

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