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Vol. 32. Issue 4.
Pages 175-182 (July - August 2020)
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Vol. 32. Issue 4.
Pages 175-182 (July - August 2020)
Review article
DOI: 10.1016/j.artere.2020.07.001
Lipid-lowering treatment in secondary prevention of ischaemic cerebrovascular disease
Tratamiento hipolipemiante en la prevención secundaria de la enfermedad cerebrovascular isquémica
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Elisenda Climenta,b, David Benaigesa,b,c, Juan Pedro-Boteta,b,c,
Corresponding author
86620@parcdesalutmar.cat

Corresponding author.
a Servicio Endocrinología y Nutrición, Hospital del Mar, Barcelona, Spain
b Departament de Medicina, Universitat Autònoma de Barcelona, Campus Universitari Mar, Barcelona, Spain
c Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Barcelona, Spain
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Table 1. Established or transient ischaemic stroke reduction in the main statin intervention studies.
Table 2. SPARCL study results and subsequent sub-analysis.
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Abstract

Stroke is the second cause of death after myocardial infarction, and the main cause of acquired disability. Patients with ischaemic stroke have a higher risk of future vascular events, including recurrent stroke, myocardial infarction, and death by vascular cause. The initial epidemiological studies demonstrated a weak or non-existent relationship between cholesterolaemia and stroke. Subsequently, statin intervention trials showed a reduction in the risk of recurrence of cerebrovascular events. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), the first clinical trial designed to assess effects of statin therapy in secondary stroke prevention, highlighted the reduction of stroke recurrence with atorvastatin 80 mg/daily in patients with a recent ischaemic established or transient stroke, with a modest increase in the rate of haemorrhagic stroke. Successive studies have also reported the benefits of statin therapy combined with ezetimibe or PCSK9 inhibitors in primary and secondary ischaemic stroke prevention. Since 80% of recurrent cerebrovascular events could be prevented, it is considered of interest to carry out a narrative review of the benefits of lipid-lowering therapy in the secondary prevention of ischaemic cerebrovascular disease.

Keywords:
Cholesterol
Statins
Ezetimibe
Ischemic stroke
PCSK9 inhibitors
Resumen

El accidente cerebrovascular es la segunda causa de mortalidad después del infarto de miocardio y la principal causa de discapacidad adquirida. Los pacientes con ictus isquémico tienen un elevado riesgo de posteriores episodios vasculares, incluyendo ictus recurrente, infarto de miocardio y muerte de causa vascular. Los primeros estudios epidemiológicos mostraron una relación débil o inexistente entre la colesterolemia y el ictus. Posteriormente, los estudios de intervención con estatinas revelaron una reducción del riesgo de recurrencia de episodios cerebrovasculares. El Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL), primer ensayo clínico diseñado para analizar los efectos de la terapia con estatinas en la prevención secundaria del ictus, demostró que el tratamiento con atorvastatina 80 mg/día reducía la recurrencia de ictus en pacientes con un accidente cerebrovascular isquémico reciente establecido o transitorio, con un modesto aumento en la tasa de ictus hemorrágico. Estudios posteriores han recabado los beneficios de la terapia de estatinas, con ezetimiba o inhibidores de PCSK9 tanto en la prevención primaria como secundaria del accidente cerebrovascular isquémico. Dado que el 80% de los episodios cerebrovasculares recurrentes pueden prevenirse hemos considerado de interés realizar una revisión narrativa de los beneficios de la terapia hipolipemiante en la prevención secundaria de la enfermedad cerebrovascular isquémica.

Palabras clave:
Colesterol
Estatinas
Ezetimiba
Ictus isquémico
Inhibidores PCSK9

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