More information about text formats
Thank you transfer a letter of James M. Howard to me. Here is my discussion.
In this clinical research, we mainly focus on the efficacy and safety of Ginkgo in combination with aspirin in acute ischemic stroke and its impact on the recurrence of vascular events. However, the underlying molecular mechanisms are worth to be explored because of their effectiveness.
Although there have been reviewed that cortisol levels are high for at least 7 days after stroke and elevated cortisol after stroke is associated with dependency, morbidity, and mortality  . There is insufficient evidence to relate the severity of ischemic stroke with cortisol because cortisol can be influenced by diurnal rhythm, food, life style and so on. There has been no evidence to ascribe cortisol both by Ginkgo and aspirin directly to improve cognitive and neurological function. There has been reported that lower levels of DHEAS were associated with an increased risk of ischemic stroke , but few literatures show that reductions in cortisol increase the positive effects of DHEA on brain functions.
The potential mechanisms of Ginkgo and aspirin have not been clear. Notably, it has been found that Ginkgo plus aspirin can enhance the expressions of LOX-1 and p-p38MAPK correlated with the inhibition of ROS production, LOX-1 expression and p38MAPK phosphorylation in human coronaryartery endothelial cells ....
The potential mechanisms of Ginkgo and aspirin have not been clear. Notably, it has been found that Ginkgo plus aspirin can enhance the expressions of LOX-1 and p-p38MAPK correlated with the inhibition of ROS production, LOX-1 expression and p38MAPK phosphorylation in human coronaryartery endothelial cells . Also, Ginkgo plus aspirin reduced transcription of TGF-β1, MMP-2 and MMP-9 genes and by the decreased expression of type I collagen,MMP-2 and MMP-9 proteins in myocardial cells . We may investigate the novel mechanisms according to clues above.
 Amanda Jayne Barugh, et al. Cortisol levels and the severity and outcomes of acute stroke: a systematic review [J]. J Neurol. 2014 March ; 261(3): 533–545.
 Monik C. Jiménez, ScD, Qi Sun, MD, ScD, et al. Low dehydroepiandrosterone sulphate is associated with increased risk of ischemic stroke among women: DHEAS and Risk of Ischemic Stroke in Women [J]. Stroke. 2013 July ; 44(7).
 Xianguan Zhua, Zhongdong Li, et al. Ginkgo biloba extract and Aspirin synergistically attenuate activated platelet-induced ROS production and LOX-1 expression in human coronary artery endothelial cells [J]. Phytomedicine. 2013. 20:114-119.
 Wei Li, Zhenhua Luo, Xingde Liu, Lingyun Fu, et al. Effect of Ginkgo biloba extract on experimental cardiac remodeling [J]. BMC Complementary and Alternative Medicine. 2015.15:277
I suggest the positive effect of combined aspirin and ginkgo post ischemic stroke is reduced cortisol. Aspirin and ginkgo both reduce cortisol. Increased reduction of cortisol by both produces more "improved cognitive and neurological functions" than aspirin alone. Furthermore, I suggest reductions in cortisol increase the positive effects of dehydroepiandrosterone (DHEA) on brain functions.