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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?

  • Cerebrovascular Disorders (D Jamieson, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

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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Authors and Affiliations

  1. Vascular Risk Unit, Department of Internal Medicine, Hospital Virgen Macarena, Avenida Dr. Fedriani n°3, 41009, Seville, Spain

    Luis Castilla-Guerra MD, PhD, David Leon-Jimenez MD & Miguel Angel Rico-Corral MD, PhD

  2. Associate Professor, Faculty of Medicine, University of Seville, Seville, Spain

    Luis Castilla-Guerra MD, PhD, María del Carmen Fernandez-Moreno MD, PhD & Miguel Angel Rico-Corral MD, PhD

  3. Department of Neurology, Hospital de Valme, Seville, Spain

    María del Carmen Fernandez-Moreno MD, PhD

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  1. Luis Castilla-Guerra MD, PhD
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  2. María del Carmen Fernandez-Moreno MD, PhD
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  3. David Leon-Jimenez MD
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  4. Miguel Angel Rico-Corral MD, PhD
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Correspondence to Luis Castilla-Guerra MD, PhD.

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Castilla-Guerra, L., Fernandez-Moreno, M., Leon-Jimenez, D. et al. Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?. Curr Treat Options Neurol 21, 22 (2019). https://doi.org/10.1007/s11940-019-0563-4

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