Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece.
Hellenic Stroke Association, Athens, Greece.
Int J Stroke. 2020 Jun;15(4):377-384. doi: 10.1177/1747493019873594. Epub 2019 Sep 7.
To reassess the effect of statin-based lipid-lowering therapy on ischemic stroke in primary and secondary prevention trials with regard to achieved levels of low-density lipoprotein-cholesterol in view of the availability of novel potent hypolipidemic agents.
English literature was searched (up to November 2018) for publications restricted to trials with a minimum enrolment of 1000 and 500 subjects for primary and secondary prevention, respectively, meeting the following criteria: adult population, randomized controlled design, and recorded outcome data on ischemic stroke events. Data were meta-analyzed and curve-estimation procedure was applied to estimate regression statistics and produce related plots.
Four primary prevention trials and four secondary prevention trials fulfilled the eligibility criteria. Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary (risk ratio, RR 0.70, 95% confidence interval, CI, 0.60-0.82; < 0.001) and in the secondary prevention setting (RR 0.80, 95% CI 0.70-0.90; < 0.001). Curve-estimation procedure revealed a linear relationship between the absolute risk reduction of ischemic stroke and active treatment-achieved low-density lipoprotein-cholesterol levels in secondary prevention (adjusted R-square 0.90) in support of "the lower the better" hypothesis for stroke survivors. On the other hand, the cubic model followed the observed data well in primary prevention (adjusted R-square 0.98), indicating greater absolute risk reduction in high-risk cardiovascular disease-free individuals.
Statin-based lipid-lowering is effective both for primary and secondary prevention of ischemic stroke. Most benefit derives from targeting disease-free individuals at high cardiovascular risk, and by achieving low treatment targets for low-density lipoprotein-cholesterol in stroke survivors.
鉴于新型强效降脂药物的出现，重新评估基于他汀类药物的降脂治疗对原发性和继发性预防试验中缺血性卒中的影响，考虑到达到的低密度脂蛋白胆固醇水平。
检索英文文献（截至 2018 年 11 月），仅纳入至少有 1000 名和 500 名原发性和继发性预防患者的试验，分别符合以下标准：成人人群、随机对照设计、记录缺血性卒中事件的结局数据。对数据进行荟萃分析，并应用曲线估计程序估计回归统计数据并生成相关图。
四项原发性预防试验和四项继发性预防试验符合入选标准。降脂治疗与原发性预防（风险比，RR 0.70，95%置信区间，CI，0.60-0.82； < 0.001）和继发性预防（RR 0.80，95% CI 0.70-0.90； < 0.001）中的缺血性卒中风险降低相关。曲线估计程序显示，继发性预防中缺血性卒中的绝对风险降低与积极治疗达到的低密度脂蛋白胆固醇水平之间存在线性关系（校正 R 平方为 0.90），支持“越低越好”假说。另一方面，初级预防中立方模型很好地遵循了观察到的数据（校正 R 平方为 0.98），表明在无高心血管疾病风险的高危个体中，绝对风险降低更大。
基于他汀类药物的降脂治疗对缺血性卒中的一级和二级预防均有效。最大获益源自针对无心血管疾病高风险的个体，并在卒中幸存者中实现低密度脂蛋白胆固醇的低治疗目标。
