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Int J Stroke. 2019 Sep 7:1747493019873594. doi: 10.1177/1747493019873594. [Epub ahead of print]

Statin-based therapy for primary and secondary prevention of ischemic stroke: A meta-analysis and critical overview.

Author information

1
1 Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
2
2 Hellenic Stroke Association, Athens, Greece.
3
3 Department of Internal Medicine, University of Thessaly, Larissa, Greece.
4
4 First Department of Neurology, Eginitio Hospital, University of Athens, Greece.
5
5 Division of Brain Diseases, Imperial College, London, UK.
6
6 Neurology Service, Lausanne University Hospital, Lausanne, Switzerland.

Abstract

BACKGROUND AND AIMS:

To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents.

METHODS:

English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots.

RESULTS:

Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60-0.82; p < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70-0.90; p < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of "the lower the better" hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals.

CONCLUSIONS:

Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.

KEYWORDS:

Cholesterol; ischemic stroke; lipid lowering; meta-analysis; prevention; statin

PMID:
31496436
DOI:
10.1177/1747493019873594

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