Association Between Intensity of Low-Density Lipoprotein Cholesterol Reduction With Statin-Based Therapies and Secondary Stroke Prevention

Abstract

The benefits and risks associated with intensive low-density lipoprotein cholesterol (LDL-C)-lowering statin-based therapies to lessen the risk of recurrent stroke have not been established.OBJECTIVE To conduct a meta-analysis of randomized clinical trials to evaluate the association of more intensive vs less intensive LDL-C-lowering statin-based therapies with outcomes for patients with ischemic stroke.

Regarding the new ESO guideline on pharmacological interventions for long-term secondary prevention after ischemic stroke or transient ischemic attack: Current evidence does not allow simplified recommendations

“…In fact, a recent meta-analysis observed that the beneficial effects of high-intensity vs. low-intensity LDL lowering for secondary stroke prevention were present in trials with all patients having evidence of atherosclerosis but not in trials with most patients not having evidence of atherosclerosis (p = 0.04 for interaction). 5 What is more, high-intensity versus low-intensity LDL lowering may come along with a…”

“…In fact, a recent meta-analysis observed that the beneficial effects of high-intensity vs. low-intensity LDL lowering for secondary stroke prevention were present in trials with all patients having evidence of atherosclerosis but not in trials with most patients not having evidence of atherosclerosis ( p = 0.04 for interaction). 5 What is more, high-intensity versus low-intensity LDL lowering may come along with a slightly increased risk of intracerebral hemorrhage and new-onset diabetes. 5 Would the authors recommend statins in individuals with stroke associated with patent foramen ovale or due to cervical artery dissection without checking on cholesterol levels?…”

“…5 What is more, high-intensity versus low-intensity LDL lowering may come along with a slightly increased risk of intracerebral hemorrhage and new-onset diabetes. 5 Would the authors recommend statins in individuals with stroke associated with patent foramen ovale or due to cervical artery dissection without checking on cholesterol levels?…”

Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank

“…Open access 3-hydroxy-methylglutaryl-coA reductase inhibitors (statins), which can reduce LDL-C and change HDL-C/ LDL-C ratio, have been widely applied for prevention of stroke and coronary artery disease. 7 The HDL-C/LDL-C ratio, a CVD predictor, reflects the protective and atherogenic lipoprotein balance. 8 The relationships between HDL-C/LDL-C and myocardial infarction (MI), all-cause mortality, haemorrhagic stroke and ischaemic stroke need to be further investigated.…”

“…Low-density lipoprotein cholesterol (LDL-C) is a CVD risk factor 6. 3-hydroxy-methylglutaryl-coA reductase inhibitors (statins), which can reduce LDL-C and change HDL-C/LDL-C ratio, have been widely applied for prevention of stroke and coronary artery disease 7. The HDL-C/LDL-C ratio, a CVD predictor, reflects the protective and atherogenic lipoprotein balance 8.…”