The role of lipid-lowering treatment in the secondary prevention of ischemic stroke

Eirini Konstantinidou, Konstantinos Tziomalos



Dyslipidemia is a major risk factor for ischemic stroke. The primary goal of lipid-lowering therapy in patients with a history of ischemic stroke is low-density lipoprotein cholesterol (LDL-C) and the drug of choice for the achievement of this goal is statins. Recommended statins include atorvastatin 40-80 mg and rosuvastatin 20-40 mg. In patients who cannot achieve LDL-C targets despite treatment with these statins, addition of ezetimibe is recommended. In selected patients with LDL-C levels > 100 mg/dl despite administration of statins combined with ezetimibe, addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor should be considered. Limited data exist regarding the role of fibrates and omega-3 fatty acids in the secondary prevention of ischemic stroke.

Keywords: ischemic stroke, dyslipidemia, statins, ezetimibe, PCSK9 inhibitors