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Lipid-Lowering Therapy Use When Indicated and Subsequent Ischemic Stroke Severity.

Barbara Gordon-Kundu1, Reza Peyravi2, Anisha Garg3

  • 1Department of Neurology, Division of Cerebrovascular Diseases Hackensack Meridian School of Medicine Nutley NJ USA.

Journal of the American Heart Association
|December 19, 2024
PubMed
Summary

Lipid-lowering therapy (LLT) is underused in patients experiencing acute ischemic stroke (AIS). Not using LLT when indicated is linked to more severe stroke symptoms, highlighting the importance of cholesterol management.

Keywords:
atherosclerosischolesterolischemic strokelipid‐lowering therapystatins

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Area of Science:

  • Cardiology
  • Neurology
  • Public Health

Background:

  • Elevated low-density lipoprotein cholesterol is a significant risk factor for atherosclerotic cardiovascular disease, including acute ischemic stroke (AIS).
  • Guidelines recommend lipid-lowering therapy (LLT) to prevent cardiovascular events, yet its use in AIS patients needs evaluation.
  • This study examines LLT utilization at the time of AIS based on guidelines and its association with stroke severity.

Purpose of the Study:

  • To assess the adherence to LLT guidelines in patients with AIS.
  • To determine if prestroke LLT use influences stroke severity.
  • To identify potential gaps in cholesterol management for stroke prevention.

Main Methods:

  • Retrospective study of AIS patients (2015-2020) at a major academic stroke center.
  • Inclusion criteria: AIS due to small-vessel disease or large-artery atherosclerosis with a prestroke indication for LLT.
  • Propensity score subclassification and adjusted logistic regression analyzed the association between prestroke LLT and presenting National Institutes of Health Stroke Scale (NIHSS) score >4.

Main Results:

  • Out of 384 eligible AIS patients, only 54% (207) received guideline-recommended prestroke LLT.
  • Underuse of LLT was significantly associated with a higher likelihood of presenting with NIHSS score >4 (OR, 1.13; 95% CI, 1.03-1.20; P=0.006).
  • This association persisted even after adjusting for the specific cause of stroke.

Conclusions:

  • Lipid-lowering therapy is underutilized in patients with atherosclerosis-related AIS.
  • Lack of prestroke LLT is linked to more severe stroke symptoms at presentation.
  • Prescribing LLT when indicated is crucial for potentially mitigating poststroke disability.