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01.05.2019 | Cerebrovascular Disorders (D Jamieson, Section Editor)

Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?

verfasst von: Luis Castilla-Guerra, MD, PhD, María del Carmen Fernandez-Moreno, MD, PhD, David Leon-Jimenez, MD, Miguel Angel Rico-Corral, MD, PhD

Erschienen in: Current Treatment Options in Neurology | Ausgabe 5/2019

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Abstract

Purpose of review

We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.

Recent findings

Recently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lowering medications: IMPROVE-IT with ezetimibe on top of simvastatin and PCSK9 inhibitors—FOURIER with evocolumab and ODYSSEY-OUTCOMES with alirocumab—on top of statin therapy.

Summary

LDL-cholesterol remains the primary lipid treatment target for reduction of stroke risk. Randomized trials have shown that each reduction of 40 mg/dL in the level of LDL-cholesterol reduces the stroke risk by approximately one quarter, and further, reductions in LDL-cholesterol levels have shown to produce additional reductions in stroke risk. Currently, we have evidence of benefit for adding non-statin lipid-modifying therapies to statins to reduce stroke risk. Surely, these novel strategies to reduce residual lipidic risk will provide future benefits on stroke prevention.

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Titel: Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?
verfasst von: Luis Castilla-Guerra, MD, PhD
María del Carmen Fernandez-Moreno, MD, PhD
David Leon-Jimenez, MD
Miguel Angel Rico-Corral, MD, PhD
Publikationsdatum: 01.05.2019
Verlag: Springer US
Erschienen in: Current Treatment Options in Neurology / Ausgabe 5/2019
Print ISSN: 1092-8480
Elektronische ISSN: 1534-3138
DOI: https://doi.org/10.1007/s11940-019-0563-4

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Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?

Abstract

Purpose of review

Recent findings

Summary

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Springer Medizin

Abstract

Purpose of review

Recent findings

Summary

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Leitlinien kompakt für die Neurologie

Neu im Fachgebiet Neurologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Demenzkranke durch Antipsychotika vielfach gefährdet

Parkinson-Therapie im Wandel – aktuelle Leitlinie im Fokus

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

Update Neurologie