Statins in Stroke Prevention: Present and Future

Over the last decades, the reduction of the mortality and morbidity of stroke has been a high- priority objective worldwide. Statins, or 3-hydroxy-3- methylglutaryl coenzyme A (HMG- CoA) reductase inhibitors, have emerged as the predominant preventive strat egy to tackle the worldwide stroke burden. Currently, statins are considered the most important advance in stroke prevention since the introduction of aspirin and antihypertensive treatments.

In this paper we review the current evidence regarding the role of statins in the stroke prevention and future directions in this field.

A meta-analysis of random ised trials of statins has shown that each 1 mmol/L (39 mg/dL) decrease in low-density lipoprotein cholesterol, equates to a reduction in relative risk for stroke of 21.1%. Statins are now recommended for the primary prevention of ischemic stroke in patients estimated to have a high 10-year risk for cardiovascular events. Nevertheless, until recently there was little evidence that statin therapy reduced the risk of stroke recurrence. The SPARCL, published in 2006, was the first trial to show the benefits of statin therapy in preventing recurrent stroke. Now we know that statins reduce the risk of stroke recurrence by 12-16% and statins are recommended among patients with ischemic stroke or TIA presumed to be of atherosclerotic origin or with other comorbid atherosclerotic cardiovascular disease.

Traditionally, there has been no clear data demonstrating that adding other lipid-modifying drugs to statins results in a further decrease in stroke or other cardiovascular event, but now things have changed and future directions include combinations with ezetimibe and new treatments such as PCSK9 inhibitors. Only time will tell the real roll of these new promising non-statin lipidmodifying therapies on stroke prevention.