Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Sagris, Dimitrios; Ntaios, George; Georgiopoulos, Georgios; Kakaletsis, Nikolaos; Elisaf, Moses; Katsiki, Niki; Korompoki, Eleni; Kypreos, Kyriakos E.; Boutari, Chrysoula; Bilianou, Helen; Makaritsis, Konstantinos; Nomikos, Tzortzis; Papavasileiou, Vasileios; Pitsavos, Christos; Plomaritoglou, Androniki; Spengos, Konstantinos; Τζιόμαλος, Κωνσταντίνος; Tselepis, Alexandros D.; Vemmos, Konstantinos; Liberopoulos, Evangelos; Milionis, Haralampos

doi:10.1177/1747493020971970

Cited by 14 publications

(10 citation statements)

References 65 publications

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“…For such patients, it is suggested that lipid lowering treatment should be based on a personalized 10-year cardiovascular risk, estimated by the calibrated country-specific SCORE. 153 Figure 3 shows the proposed management of dyslipidaemia in IS.…”

Section: ‘C’: Cardiovascular Risk Factors and Comorbidities Optimizationmentioning

confidence: 99%

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Lip

Boriani

Doehner

et al. 2022

European Heart Journal

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The management of patients with stroke is often multidisciplinary, involving various specialties and healthcare professionals. Given the common shared risk factors for stroke and cardiovascular disease, input may also be required from the cardiovascular teams, as well as patient caregivers and next-of-kin. Ultimately, the patient is central to all this, requiring a coordinated and uniform approach to the priorities of post-stroke management, which can be consistently implemented by different multidisciplinary healthcare professionals, as part of the patient ‘journey’ or ‘patient pathway,’ supported by appropriate education and tele-medicine approaches. All these aspects would ultimately aid delivery of care and improve patient (and caregiver) engagement and empowerment. Given the need to address the multidisciplinary approach to holistic or integrated care of patients with heart disease and stroke, the European Society of Cardiology Council on Stroke convened a Task Force, with the remit to propose a consensus on Integrated care management for optimizing the management of stroke and associated heart disease. The present position paper summarizes the available evidence and proposes consensus statements that may help to define evidence gaps and simple practical approaches to assist in everyday clinical practice. A post-stroke ABC pathway is proposed, as a more holistic approach to integrated stroke care, would include three pillars of management: • A: Appropriate Antithrombotic therapy. • B: Better functional and psychological status. • C: Cardiovascular risk factors and Comorbidity optimization (including lifestyle changes).

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Section: ‘C’: Cardiovascular Risk Factors and Comorbidities Optimizationmentioning

confidence: 99%

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Lip

Boriani

Doehner

et al. 2022

European Heart Journal

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“…The second example is a guideline by the Hellenic Stroke Organization and Hellenic Atherosclerosis Society. 9 Authors reported that (1) patients with ischemic stroke or TIA should receive lipid-modifying treatment with a high-intensity statin (grade of recommendation/level of evidence, 1A) and (2) patients with ischemic stroke or TIA should be treated with an LDL-C target <55 mg/dL and at least 50% reduction of baseline LDL-C levels (1B). Finally, the European Stroke Organization (ESO)-Karolinska guideline 10 reported that "Statins should be used as a part of secondary prophylactic treatment after an ischemic stroke or TIA."…”

Section: Comments On Recent Guidelinesmentioning

confidence: 99%

“…Based on these results, recent guidelines have recommended the use of a high-dose statin with a low LDL-C target in patients with ischemic stroke. [8][9][10] However, there are concerns that this strategy may not be universally applied to all patients with ischemic stroke. In the HPS trial, 3 among participants with prior stroke, there was no apparent reduction in the incidence of recurrent stroke (rate ratio, 0.98; 95% CI, 0.79 to 1.22) in the simvastatin group, even if there was a significant reduction in the rate of any major vascular event (406 [24.7%] vs. 488 [29.8%], P=0001).…”

Section: Introductionmentioning

confidence: 99%

Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines

Kim

2021

J Stroke

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Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of “high-intensity statins” and “low LDL-C target” strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.

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“…The authors discuss the benefit of statins and low LDL-C levels in patients with cardioembolic stroke as shown by several studies. However, there is no specific recommendation for this patient population 59 . Overall, no organization makes a definite statement or suggestion regarding LLT in patients with AF-related stroke.…”

Section: Overview Of Current Guidelines Regarding Llt In Patients With Strokementioning

confidence: 99%

Ischemic stroke in patients with atrial fibrillation – do we need to treat with statins?

Florentin¹,

Ntaios²,

Milionis³

2021

JAPT

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The relationship of dyslipidemia with atrial fibrillation (AF)-related stroke is not clear. The question whether patients with AF-related stroke should receive lipid lowering agents unanimously remains unanswered. Treatment with statins does not appear to be as protective as initially thought in terms of AF prevention; however, certain groups of patients may benefit from statin use. There is evidence that statins favorably affect stroke severity, in-hospital mortality, prognosis and survival of patients with AF-related stroke. Statin pretreatment is associated with better collateral circulation in patients with cardioembolic stroke. Importantly, AF frequently co-exists with several cardiovascular comorbidities, while patients with AF-related stoke may be prone to other cardiovascular events. The overall cardiovascular risk should be assessed in AF patients experiencing a stroke and treated in accordance with the proposed low density lipoprotein cholesterol (LDL-C) targets.

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Recommendations for lipid modification in patients with ischemic stroke or transient ischemic attack: A clinical guide by the Hellenic Stroke Organization and the Hellenic Atherosclerosis Society

Cited by 14 publications

References 65 publications

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Integrated care for optimizing the management of stroke and associated heart disease: a position paper of the European Society of Cardiology Council on Stroke

Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines

Ischemic stroke in patients with atrial fibrillation – do we need to treat with statins?

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