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Low-density Lipoprotein Cholesterol Reduction Therapies for Secondary Prevention in Patients with Stroke: A Network

Xing Wang1, Jun Zheng1, Yuqi Chen1

  • 1West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.

Current Neuropharmacology
|October 26, 2023
PubMed

Insights

Ezetimibe plus statins effectively reduce recurrent stroke risk, outperforming statins alone. However, statin monotherapy may increase hemorrhagic stroke risk, highlighting the importance of tailored LDL-C-lowering strategies.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Patients with prior strokes face elevated risks of recurrence.
  • Current guidelines advocate for low-density lipoprotein cholesterol (LDL-C)-lowering therapies for secondary stroke prevention.
  • The optimal LDL-C-lowering agent for preventing recurrent stroke remains undetermined.

Purpose of the Study:

  • To evaluate the comparative efficacy of various LDL-C-lowering agents in secondary stroke prevention.
  • To identify the most effective treatment strategy for reducing recurrent stroke incidence.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) up to 2022.
  • Included studies compared different LDL-C-lowering agents in adult patients with a history of stroke.
  • Recurrent stroke was the primary endpoint, with Surface Under the Cumulative Ranking Curve (SUCRA) used for treatment ranking.

Main Results:

  • Nine RCTs involving 17,226 patients were analyzed.
  • Ezetimibe plus statins (RR: 0.56) and statins alone (RR: 0.90) significantly reduced recurrent stroke risk.
  • Ezetimibe plus statins demonstrated superior efficacy over statins alone (RR: 0.62) in preventing recurrent strokes.
  • Statin monotherapy was associated with an increased risk of hemorrhagic stroke (RR: 1.57) compared to placebo.
  • All investigated agents decreased the incidence of major adverse cardiovascular events.

Conclusions:

  • Combination therapy with ezetimibe and statins is the most effective strategy for reducing recurrent stroke incidence.
  • Statin monotherapy is linked to an elevated risk of hemorrhagic stroke, necessitating careful consideration in treatment selection.
Abstract

Keywords:
Ischemic strokePCSK9cardiovascular events.hemorrhagic strokelow-density lipoproteinsecondary prevention

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