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Review
. 2023 Apr 17;59(4):776.
doi: 10.3390/medicina59040776.

Medical Management of Dyslipidemia for Secondary Stroke Prevention: Narrative Review

Yoonkyung Chang  1 , Soojeong Eom  2 , Minjeong Kim  2 , Tae-Jin Song  3
Affiliations
Review

Medical Management of Dyslipidemia for Secondary Stroke Prevention: Narrative Review

Yoonkyung Chang et al. Medicina (Kaunas). .

Abstract

Dyslipidemia is a major risk factor for stroke, following hypertension, diabetes, and smoking, and is an important risk factor for the prevention and treatment of coronary artery disease and peripheral vascular disease, including stroke. Recent guidelines recommend considering low-density lipoprotein cholesterol (LDL-C)-lowering therapies, such as statins (preferably), ezetimibe, or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors to prevent the occurrence or recurrence of stroke, adhering to the "lower is better" approach. In this review, we examined the evidence supporting lipid-lowering medications like statins, ezetimibe, and PCSK9 inhibitors for secondary stroke prevention and dyslipidemia management in different stroke subtypes. Stroke guidelines advocate for administering the maximum tolerable dose of statins as the primary treatment and as soon as possible despite the potential for new-onset diabetes mellitus and possible muscle and liver toxicity due to their demonstrated benefits in secondary prevention of cardiovascular diseases and mortality reduction. When statin use is insufficient for LDL lowering, ezetimibe and PCSK9 inhibitors are recommended as complementary therapies. It is essential to establish lipid-lowering therapy goals based on the stroke subtype and the presence of comorbidities.

Keywords: PCSK9 inhibitor; dyslipidemia; ezetimibe; statin; stroke.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 3
Figure 3
The strategy of statin treatment for muscle toxicity [56].
Figure 4
Figure 4
The strategy of statin treatment for liver toxicity [56].
Figure 1
Figure 1
Beneficial effects of statins. Statins have pleiotropic effects such as improvement of vascular endothelial cell function, improvement of nitric oxide bioavailability, antioxidant effects, inhibition of inflammatory response, and stabilization of atherosclerotic plaques.
Figure 2
Figure 2
Comparison of side effects among different statins. Horizontal bars indicate ORs with 95% CIs for the complications of statins. Vertical line indicates OR of 1 (no association). ORs, odds ratios; CIs, confidence intervals.
Figure 5
Figure 5
Management of dyslipidemia for secondary stroke prevention.
See this image and copyright information in PMC

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