Abstract
Dyslipidemia is a major modifiable risk factor for ischemic stroke. Treatment with statins reduces the incidence of recurrent ischemic stroke and also reduces coronary events in patients with a history of ischemic stroke. Therefore, statins represent an important component of secondary prevention of ischemic stroke. In patients who do not achieve low-density lipoprotein cholesterol (LDL-C) targets despite treatment with the maximal tolerated dose of a potent statin, ezetimibe should be added to their lipid-lowering treatment and also appears to reduce the risk of cardiovascular events. Selected patients who do not achieve LDL-C targets despite statin/ezetimibe combination are candidates for receiving proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Finally, it appears that adding icosapent ethyl might also reduce cardiovascular morbidity in patients who have achieved LDL-C targets but have persistently elevated triglyceride levels.
Highlights
The Role of Lipid-LoweringIschemic stroke represents the fourth leading cause of death and the first cause of longterm disability in high-income countries [1,2]
Randomized trials in patients with ischemic stroke showed a reduction in cardiovascular morbidity after treatment with a statin compared with placebo [8,9]
The present review summarizes the current evidence regarding the role of lipidlowering treatment in the secondary prevention of ischemic stroke
Summary
Ischemic stroke represents the fourth leading cause of death and the first cause of longterm disability in high-income countries [1,2]. High low-density lipoprotein cholesterol (LDL-C) levels are a major modifiable risk factor for ischemic stroke [3]. High levels of triglycerides and low levels of high-density lipoprotein cholesterol (HDL-C) are related to increased risk for ischemic stroke [4,5]. Elevated total cholesterol levels are a risk factor for carotid stenosis, a major cause of ischemic stroke [7]. Randomized trials in patients with ischemic stroke showed a reduction in cardiovascular morbidity after treatment with a statin compared with placebo [8,9]. Additional confusion is created by the association between low LDL-C levels and increased risk for hemorrhagic stroke [1], as well asby reports that aggressive statin treatment might increase the risk of hemorrhagic stroke in patients with a history of an ischemic stroke [8].
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