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Differential Effects of Lipid-lowering Drugs in Modulating Morphology of Cholesterol Particles
Published on: November 10, 2017
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Lipid-Modifying Therapies and Stroke Prevention.
Daniel G Hackam1,2,3, Robert A Hegele4
1Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Room 100K-2, Siebens Drake Bldg, 1400 Western Rd, London, Ontario, N6G 2V2, Canada. dhackam@uwo.ca.
Current Neurology and Neuroscience Reports
|May 13, 2022
Summary
Newer lipid-modifying therapies, including PCSK9 inhibitors and icosapent ethyl, effectively reduce ischemic stroke risk without increasing hemorrhagic stroke risk. These advancements offer expanded options for stroke prevention in high-risk individuals.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Stroke remains a leading cause of disability and mortality worldwide.
- Effective lipid modification is crucial for cerebrovascular event prevention.
- Emerging therapies offer new avenues for managing dyslipidemia and reducing stroke risk.
Purpose of the Study:
- To review current lipid-modifying therapies and their impact on stroke and cerebrovascular outcomes.
- To focus on the efficacy and safety of newer agents in stroke risk reduction.
- To evaluate the role of novel lipid-lowering drugs in preventing ischemic and hemorrhagic strokes.
Main Methods:
- Review of clinical trials and observational studies on lipid-modifying agents.
- Analysis of data on ischemic and hemorrhagic stroke risk associated with various therapies.
- Inclusion of studies on statins, ezetimibe, PCSK9 inhibitors, icosapent ethyl, and emerging agents.
Main Results:
- Statins and ezetimibe demonstrate reduced ischemic stroke risk without increasing hemorrhagic stroke risk.
- Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors show similar benefits in atherosclerosis patients, even with very low LDL-C.
- Icosapent ethyl significantly lowers total and first ischemic stroke risk in patients with cardiovascular disease or diabetes.
- Ongoing trials investigate inclisiran, bempedoic acid, pemafibrate, evinacumab, pelacarsen, olpasiran, and SLN360.
Conclusions:
- Established and newer lipid-modifying therapies, including PCSK9 inhibitors and icosapent ethyl, effectively reduce ischemic stroke risk.
- These agents do not appear to increase the risk of hemorrhagic stroke.
- These therapies provide expanded and improved options for stroke risk reduction in high-risk populations.
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