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Lipid-lowering treatment in secondary prevention of ischaemic cerebrovascular disease
Elisenda Climent1, David Benaiges2, Juan Pedro-Botet2
1Servicio de Endocrinología y Nutrición, Hospital del Mar, Barcelona, España; Departament de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, España.
Insights
Lipid-lowering therapies, including statins, significantly reduce the risk of recurrent ischemic stroke. These treatments are crucial for preventing future vascular events and improving outcomes for stroke survivors.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Stroke is a leading cause of death and disability.
- Ischemic stroke patients face high risks of recurrent vascular events.
- Early studies showed a weak link between cholesterol and stroke, but later trials revealed benefits of lipid-lowering therapy.
Purpose of the Study:
- To review the benefits of lipid-lowering therapy in secondary prevention of ischemic cerebrovascular disease.
- To highlight the efficacy of statins and other agents in reducing stroke recurrence.
Main Methods:
- Narrative review of clinical trials and epidemiological studies.
- Focus on lipid-lowering therapies such as statins, ezetimibe, and PCSK9 inhibitors.
- Analysis of data from trials like SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels).
Main Results:
- Statin therapy, exemplified by atorvastatin 80mg/daily in the SPARCL trial, reduces stroke recurrence.
- Lipid-lowering therapies combined with ezetimibe or PCSK9 inhibitors show benefits in stroke prevention.
- A modest increase in hemorrhagic stroke was observed with high-dose statin therapy.
Conclusions:
- Lipid-lowering therapy is effective in the secondary prevention of ischemic cerebrovascular disease.
- Approximately 80% of recurrent cerebrovascular events are preventable with appropriate interventions.
- Further research and application of these therapies can significantly improve patient outcomes and reduce disability.
Abstract:
Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), the first clinical trial designed to assess effects of statin therapy in secondary stroke prevention, highlighted the reduction of stroke recurrence with atorvastatin 80mg/daily in patients with a recent ischaemic established or transient stroke, with a modest increase in the rate of haemorrhagic stroke. Successive studies have also reported the benefits of statin therapy combined with ezetimibe or PCSK9 inhibitors in primary and secondary ischaemic stroke prevention. Since 80% of recurrent cerebrovascular events could be prevented, it is considered of interest to carry out a narrative review of the benefits of lipid-lowering therapy in the secondary prevention of ischaemic cerebrovascular disease.
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