Dyslipidemia Treatment and Cerebrovascular Disease: Evidence Regarding the Mechanism of Stroke.

Q2 Medicine Journal of Lipid and Atherosclerosis Pub Date : 2024-05-01 Epub Date: 2024-02-23 DOI:10.12997/jla.2024.13.2.139
Sang Hee Ha, Bum Joon Kim
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Abstract

Dyslipidemia stands as a significant risk factor for stroke, on par with the impact of hypertension, diabetes, and smoking. While the role of dyslipidemia is firmly established in the context of coronary artery disease, its influence on strokes remains somewhat enigmatic. This complexity likely arises from the diverse mechanisms underpinning strokes, which encompass a heterogeneous spectrum (hemorrhagic and ischemic; large artery atherosclerosis, small vessel occlusion, cardioembolism, and etc.). The extent to which lipid-lowering treatments affect stroke outcomes may vary depending on the specific stroke subtype. For instance, in cases of large artery atherosclerosis (LAA), the optimal target level of low-density lipoprotein cholesterol (LDL-C) is relatively clear. However, when dealing with other stroke subtypes like small vessel occlusion or cardioembolism, the appropriate LDL-C target remains uncertain. Furthermore, reperfusion therapy has emerged as the foremost treatment for acute ischemic stroke. Nevertheless, the precise relationship between LDL-C levels and outcomes in patients undergoing reperfusion therapy remains shrouded in uncertainty. Consequently, we have undertaken an in-depth exploration of the existing evidence supporting the utilization of lipid-lowering medications such as statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. Our objective is to elucidate their role in secondary stroke prevention and the management of dyslipidemia across the various stroke subtypes.

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血脂异常治疗与脑血管疾病:有关中风机制的证据。
血脂异常是脑卒中的重要危险因素,与高血压、糖尿病和吸烟的影响不相上下。虽然血脂异常在冠状动脉疾病中的作用已得到证实,但它对脑卒中的影响却仍然有些神秘。造成这种复杂性的原因可能是脑卒中的发病机制多种多样,包括各种类型(出血性和缺血性;大动脉粥样硬化、小血管闭塞、心肌栓塞等)。降脂治疗对中风预后的影响程度可能因具体的中风亚型而异。例如,在大动脉粥样硬化(LAA)病例中,低密度脂蛋白胆固醇(LDL-C)的最佳目标水平相对明确。然而,对于小血管闭塞或心源性栓塞等其他卒中亚型,合适的低密度脂蛋白胆固醇目标值仍不确定。此外,再灌注疗法已成为急性缺血性卒中的首要治疗方法。然而,接受再灌注治疗的患者的 LDL-C 水平与预后之间的确切关系仍不确定。因此,我们对支持使用他汀类药物、依折麦布和 9 型丙蛋白转换酶亚基酶/kexin(PCSK9)抑制剂等降脂药物的现有证据进行了深入探讨。我们的目标是阐明这些药物在中风二级预防和各种中风亚型的血脂异常管理中的作用。
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来源期刊
Journal of Lipid and Atherosclerosis
Journal of Lipid and Atherosclerosis Medicine-Internal Medicine
CiteScore
6.90
自引率
0.00%
发文量
26
审稿时长
12 weeks
期刊最新文献
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