Title:Management of Dyslipidaemia for the Prevention of Stroke: Clinical
Practice Recommendations from the Lipid Association of India
Volume: 20
Issue: 2
Author(s): Raman Puri*, Vimal Mehta, Shamanna Seshadri Iyengar, Padma Srivastava, Jamal Yusuf, Akshaya Pradhan, Jeyaraj Durai Pandian, Vijay K. Sharma, Pushpendra Nath Renjen, Arumugam Muruganathan, Mugundhan Krishnan, Avathvadi Venkatesan Srinivasan, Sadanand Shetty, Sanjeevi Nathamuni Narasingan, Devaki R. Nair, Manish Bansal, Dorairaj Prabhakar, Mukul Varma, Vimal K. Paliwal, Aditya Kapoor, Saibal Mukhopadhyay, Rahul Mehrotra, Rashida Melinkari Patanwala, Rajeev Aggarwal, Kunal Mahajan, Soumitra Kumar, Neil Bardoloi, Krishna Kumar Pareek, Prabhash Chand Manoria, Arvind Kumar Pancholia, Rashmi Nanda, Nathan D. Wong and Paul Barton Duell
Affiliation:
- Cardiac Care Centre, New Delhi, India
Keywords:
Stroke, statin, ischaemic stroke, carotid stenosis, intracerebral haemorrhage, low density lipoprotein cholesterol.
Abstract: Stroke is the second most common cause of death worldwide. The rates of stroke are increasing
in less affluent countries predominantly because of a high prevalence of modifiable risk factors. The Lipid
Association of India (LAI) has provided a risk stratification algorithm for patients with ischaemic stroke
and recommended low density lipoprotein cholesterol (LDL-C) goals for those in very high risk group and
extreme risk group (category A) of <50 mg/dl (1.3 mmol/l) while the LDL-C goal for extreme risk group
(category B) is ≤30 mg/dl (0.8 mmol/l). High intensity statins are the first-line lipid lowering therapy. Nonstatin
therapy like ezetimibe and proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitors may be
added as an adjunct to statins in patients who do not achieve LDL-C goals with statins alone. In acute
ischaemic stroke, high intensity statin therapy improves neurological and functional outcomes regardless of
thrombolytic therapy. Although conflicting data exist regarding increased risk of intracerebral haemorrhage
(ICH) with statin use, the overall benefit risk ratio favors long-term statin therapy necessitating detailed
discussion with the patient. Patients who have statins withdrawn while being on prior statin therapy at the
time of acute ischaemic stroke have worse functional outcomes and increased mortality. LAI recommends
that statins be continued in such patients. In patients presenting with ICH, statins should not be started in
the acute phase but should be continued in patients who are already taking statins. ICH patients, once stable,
need risk stratification for atherosclerotic cardiovascular disease (ASCVD).
