Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China

Abstract

Background: The benefit of blood cholesterol reduction for secondary prevention of ischemic stroke remains undetermined in Chinese patients. The purpose of this meta-analysis was to determine whether lipid-lowering agents including statins, fibrates, nicotinic acid, and ezetimibe reduced the risk of recurrent stroke in ischemic stroke patients in China and whether such findings could inform treatment decisions for blood lipid-lowering treatment in China.Methods: The English electronic databases PubMed, EMBASE, Cochrane Library and Chinese databases CNKI, Sino-Med, Wan Fang, and VIP were searched for studies published between January 1990 and April 2020. This meta-analysis included published data from trials that randomly assigned patients to groups treated with either blood lipid-lowering regimens or placebo. Effect comparisons were made using fixed effects model in meta-analysis and linear and spline regression were performed to identify the relative risk of stroke recurrence. The primary outcome was the reduction of total ischemic stroke events, and relative risk values were obtained using a risk prediction equation developed from the control groups of the included trials.Results: Five studies including 4,999 individuals with available data met the inclusion criteria. Relative to the control groups, the pooled estimated odds ratio (OR) for recurrent stroke among those who received lipid-lowering therapy was 0.79 (95% confidence interval [CI]: 0.63–1.00). A 50% or greater reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduced the risk of ischemic stroke recurrence (OR: 0.15 [95% CI: 0.11–0.20]). The overall beneficial effect of statin therapy was confirmed to prevent ischemic stroke with an OR of 0.51 (95% CI: 0.36–0.72).Conclusions: Effective lipid-lowering therapy could decrease the blood LDL-C level, which had a protective effect against stroke recurrence. These results support the use of predicted baseline cerebrovascular disease risk equations to inform decisions regarding blood lipid-lowering treatment in ischemic stroke patients in China.

Prevalence of Dyslipidemia in Ischemic Stroke Patients: A Single-Center Prospective Study From Pakistan

“…A meta-analysis showed that reducing 1mmol/L LDL cholesterol reduces the risk of stroke by 21.1% [ 18 ]. Another meta-analysis showed similar results in reducing the incidence of new events [ 19 ] and re-occurrence of stroke [ 20 ] using statin therapy. However, it showed no significant reduction in fatal stroke with statin therapy [ 19 ].…”

“…It is important to take dyslipidemia as a risk factor along with other modifiable risk factors. Multiple meta-analyses have established that reducing LDL cholesterol reduces the overall risk of stroke [ 20 ]. Statins are the first-line medications for dyslipidemia, and other options include fibrates, ezetimibe, and PCSK9 inhibitors [ 21 ].…”

The Pathophysiological Associations Between Obesity, NAFLD, and Atherosclerotic Cardiovascular Diseases

“…Statins, as the most important lipid-lowering drugs, can greatly reduce the risk of cardiovascular events either as a therapeutic or preventive medication [45]. For instance, it was found that the use of a lipid-lowering drug leads to 21 % decrease in ischemic stroke [46]. A 50 % or more reduction in LDL-C profoundly reduced the risk of ischemic stroke recurrence (OR 0.15, 95 % CI 0.11-0.20) in this study [46].…”

New-onset type 2 DM risk in dyslipidemia and stroke patients due to simvastatin use

“…The primary abnormalities are the increasing levels of total cholesterol, lowdensity lipoprotein (LDL), and triglycerides (TG), as well as the decreasing level of high-density lipoprotein (HDL) [4]. Further, this disease is caused by lipid metabolism disruption due to genetic and environmental factors, and it becomes one of the risk factors of stroke [5,6]. Generally, stroke, which attacks the brain, occurs suddenly, progressively, and quickly because of local and/or global disruption of nerve function [7].…”