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Chapter 16 - Prevention of Stroke by Lowering Blood Cholesterol Concentrations

from Part V - Prevention

Published online by Cambridge University Press:  15 December 2020

Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
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Summary

Although higher plasma cholesterol concentrations have not been reported to be associated with increased stroke risk, cholesterol lowering has been reported to decrease this risk. This decrease can be achieved with statins, which are well-tolerated, provided they are not given to patients with active liver or muscle diseases. Statin treatment in addition to a healthy lifestyle is recommended for the primary prevention of ischaemic stroke in patients with pre-existing coronary heart disease or other high-risk conditions such as diabetes and hypertension. Statins with intensive lipid-lowering effects are recommended for their positive influence on reducing the risks of stroke and cardiovascular events for patients with prior ischaemic stroke or TIA presumed to be of non-cardioembolic origin, even with an LDL-C level =100 mg/dL, with or without evidence of other clinical atherosclerotic cardiovascular diseases. Despite the good safety profile of statins, further studies are clarify safety in patients with prior cerebral haemorrhage and if they may increase brain haemorrhage to a small degree. PCSK9 inhibitors are advised, as add-on therapy to statins, for patients with a high cardiac risk not able to achieve an optimal LDL-C level, though studies with longer follow-up are needed

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Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
, pp. 297 - 307
Publisher: Cambridge University Press
Print publication year: 2020

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