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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(01): e43-e50
DOI: 10.1055/s-0041-1741419
Original Article

Analysis of Serum Cholesterol, Statins and Atherosclerotic Plaque in Ruptured and Unruptured Intracranial Aneurysm

Análise de colesterol sérico, estatina e placa aterosclerótica em aneurisma intracraniano roto e não roto
Leonardo Zumerkorn Pipek 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Nícollas Nunes Rabelo 
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
,
Henrique Zumerkorn Pipek 
3   School of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
,
Joao Paulo Mota Telles 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Natalia Camargo Barbat 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Antônio Carlos Samaia da Silva Coelho 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Marcia Harumy Yoshikawa 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Guilherme Bitencourt Barbosa 
1   Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira 
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo 
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract

Introduction Intracranial aneurysm (IA) is a major healthcare concern. The use of statin to reduce serum cholesterol has shown evidence to reduce cardiovascular risk in various diseases, but the impact on IA has not been described. This study aims to determine whether statin use, and serum cholesterol levels interfere with outcomes after IA event.

Methods A cohort of patients with IA was analyzed. Patients social and demographics data were collected. Modified Rankin scale (mRS) score after 6 months of follow-up was the endpoint. The data regarding statins use, presence or not of atherosclerotic plaque in radiological images and serum cholesterol of 35 patients were included in our study. Linear regression models were used to determine the influence of those 6 variables in the clinical outcome.

Results The prevalence of atherosclerotic plaque, high cholesterol and use of statins was 34.3%, 48.5%, and 14.2%, respectively. Statins and serum cholesterol did not impact the overall outcome, measured by mRS after 6 months (p > 0.05), but did show different tendencies when separated by IA rupture status. Serum cholesterol shows an important association with rupture of aneurysm (p = 0.0382). High cholesterol and use of statins show a tendency for worse outcome with ruptured aneurysm, and the opposite is true for unruptured aneurysm. The presence of atherosclerotic plaques was not related with worse outcomes.

Conclusions Multiple and opposite mechanisms might be involved in the pathophysiology of IA. Ruptured aneurysms are associated with higher levels of serum cholesterol. Serum cholesterol and statins use were not correlated with worse outcomes, but further studies are important to clarify these relationships.

Resumo

Introdução Aneurisma intracranial (AI) é uma grande preocupação para a saúde. Evidências apontam que o uso de estatina para reduzir o colesterol sérico diminui o risco cardiovascular em diversas doenças, mas o impacto em AI ainda não foi descrito. Este estudo almeja determinar se o uso de estatina e o nível sérico de colesterol interferem no desfecho clínico após a ocorrência de AIs.

Métodos Uma coorte de pacientes com AI foi analisada. Os dados sociodemográficos dos pacientes foram coletados. Ao final de 6 meses de acompanhamento, aplicou-se a escala modificada de Rankin (mRS). Os dados sobre uso de estatina, existência de placa aterosclerótica em imagens radiológicas, e colesterol sérico de 35 pacientes foram incluídos no estudo. Modelos de regressão linear foram usados para determinar a influência dessas 6 variáveis nos desfechos clínicos.

Resultados A prevalência de placa aterosclerótica, colesterol elevado, e uso de estatina foram respectivamente 34,3%, 48,5% e 14,2%. Estatina e colesterol sérico não impactaram nos desfechos medidos pela mRS em 6 meses (p > 0,05), mas mostraram diferentes tendências quando separados pelo estado de ruptura do AI. Colesterol sérico apresenta uma importante associação com ruptura de aneurisma (p = 0,0382). Colesterol elevado e uso de estatinas representam uma tendência a piores desfechos para aneurismas rompidos, e o oposto é verdade para os não rompidos. A presença de placa aterosclerótica não está relacionada com piores resultados.

Conclusões Mecanismos múltiplos e opostos podem estar envolvidos na patofisiologia do AI. Aneurismas rompidos estão associados com maiores níveis de colesterol sérico. Colesterol sérico e estatinas não foram correlacionados com piores desfechos, mas mais estudos são importantes para clarificar a relação entre esses fatores.

Keywords

cholesterol - statins - plaques - outcomes for IA

Palavras-chave

colesterol - estatinas - placa - desfechos para AI

Ethical Standards

This research project was approved by the Ethics and Research Committee of the Hospital das Clínicas of the FMUSP. Online registration CAPPesq: 15226. Approved 06/20/2016. Approved on the Brazilian platform CAAE, number: 61719416.6.0000.0068




Publikationsverlauf

Eingereicht: 20. Juni 2021

Angenommen: 06. September 2021

Artikel online veröffentlicht:
06. Januar 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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