Statin Therapy for Stroke Prevention: Current Status and Controversies

Abstract

Statin therapy has become one of the most widely prescribed medications in the world because of its efficacy in the primary and secondary prevention of cardiovascular mortality and stroke. Current cardiovascular guidelines recommend statin use in all patients with stroke due to atherosclerosis (non-cardioembolic stroke). Statin therapy at stroke onset is associated with good functional outcome and reduced risk of cardiovascular events after stroke via different mechanisms. These include lipid-lowering effects, platelet aggregation, improved endothelial function, anti-inflammation activity, neuroprotective action, and stabilization of atherosclerotic plaques. Nevertheless, the effects of statin therapy following major stroke are uncertain and data on the optimal dose and intensity are limited. Statins may potentially increase the incidence of overall stroke and fatal stroke in patients with a history of renal transplantation, or regular hemodialysis. There is a need for additional studies since statins benefits do not extend across all etiologic subtypes of ischemic stroke: they are indicated for thrombotic strokes and some, but not all, lacunar, cardioembolic or essential strokes, and they are not suitable for ischemic strokes of unusual etiology.