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Statins

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Stroke Revisited: Dyslipidemia in Stroke

Part of the book series: Stroke Revisited ((STROREV))

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Abstract

Statins, also known as β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase inhibitors, are a class of drugs frequently prescribed for lowering cholesterols. The statins have been used for more than 30 years for the prevention of stroke and coronary artery disease. Their primary mechanism of action is via inhibition of the mevalonate pathway, resulting in a decrease of cholesterol and isoprenoid synthesis. Reduction of cholesterol synthesis enhances the uptake of extracellular low-density lipoprotein cholesterol (LDL-C) via upregulation of LDL-C receptors. The inhibition of isoprenoid synthesis results in the so-called pleiotropic effects of statins, including anti-inflammatory action, antioxidant effect, improvement of endothelial function, prevention of platelet aggregation, plaque stabilization, and regression of atherosclerosis. There are now seven commercially available statins, including Rosuvastatin, Atorvastatin, Simvastatin, Fluvastatin, Pravastatin, Lovastatin, and Pitavastatin. The key pharmacological properties of each statin are slightly different according to their solubility and chemical features. As for their implications on stroke trials, the association between pre- and post-stroke statins on stroke-related outcomes is not always consistent. Nevertheless, statins reduced the risk of stroke by 24.5–48%.

Lipid-lowering agents include several classes of medications such as β-Hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase inhibitor known as statin, cholesterol absorption inhibitor, fibric acid derivative, bile acid sequestrant, and nicotinic acid. These drugs differ in mechanism of action and common side effects and the type and degree of lipid reduction. In this chapter, we reviewed the history of statin development, mechanism of action, and drug characteristics of each statin. We also described the pleiotropic effects of statin other than lowering lipid levels on cardiovascular outcomes. Lastly, we summarized the implication of statin administration on several stroke-related outcomes.

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  1. Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea

    Minwoo Lee & Byung-Chul Lee

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  1. Department of Neurology, Seoul National University Hospital, Seoul, Korea (Republic of)

    Seung-Hoon Lee

  2. Department of Neurology, Uijeongbu Eulji Medical Center, Gyeonggi, Korea (Republic of)

    Min Kyoung Kang

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Lee, M., Lee, BC. (2021). Statins. In: Lee, SH., Kang, M.K. (eds) Stroke Revisited: Dyslipidemia in Stroke. Stroke Revisited. Springer, Singapore. https://doi.org/10.1007/978-981-16-3923-4_7

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