Lipid-lowering drugs in ischemic stroke prevention and their influence on acute stroke outcome

Abstract

Introduction: Dyslipidemia is a recognized risk factor for coronary arterial disease, but its role as risk factor for stroke has been controversial for a long time. In the last years, much attention has been paid to lipid-lowering therapies as a key preventive measure to reduce stroke risk.

Methods: We conducted a nonsystematic review of published studies analyzing the association between serum lipids and stroke risk, with special attention to the findings of clinical trials with lipid-modifying therapies (LDL-lowering drugs such as statins, HDL-increasing drugs such as torcetrapib) and to the effect of prior statin therapies on acute stroke severity.

Results: Data from large cohort prospective studies, case-control studies and clinical trials confirm the association between serum lipids and stroke risk. In secondary stroke prevention, atorvastatin 80 mg is effective in patients with prior transient ischemic attack and noncardioembolic ischemic stroke. Pretreatment with statins in stroke patients is associated with better outcomes. This protective effect is more evident in atherothrombotic and lacunar infarctions. Statin withdrawal during acute stroke is associated with loss of the protective effect, and statin discontinuation after an acute ischemic stroke is also associated with higher mortality at 1 year of follow-up.

Conclusions: Dyslipidemia is a modifiable stroke risk factor. Long treatment with atorvastatin 80 mg has been associated with reduced risk of stroke recurrences and other cardiovascular events in patients with noncardioembolic transient ischemic attack or ischemic stroke. Prior statin treatment is associated with lower stroke severity and better outcomes in acute ischemic stroke patients. Statin treatment should never be discontinued in these patients.