Statins, vascular risk factors and stroke prevention

The most widely prescribed drugs as a first-line therapy for dyslipidemia (DL) are 3-hydroxy-3-methylglutaryl-CoA inhibitors, also known as “statins”. They manifest direct and indirect neuroprotective effects, and also rapid vasoprotection, which occur independently of their cholesterol decreasing activity. Their unique properties have given to statins a place in contemporary therapy guidelines for treatment of the vascular RFs such as DL, arterial hypertension, coronary heart disease (CHD), diabetes mellitus and asymptomatic carotid stenosis in high risk patients. They are recommended for ischemic stroke (IS) primary and secondary prevention and prescribed for long periods. Statin vasoprotective and neuroprotective activities, which manifest immediately after administration, have raised discussion about their beneficial effect in acute IS, and in post-stroke recovery. The withdrawal of statin therapy worsens prognosis and increases mortality rate. There is evidence that oxidative stress and inflammation play role in depression and statin use decreases risk of depressive symptoms in CHD patients. Further well designed randomized studies are needed to investigate the efficacy and safety of statins in acute IS. A challenge for a new study on statins is clarifying whether they possess favorable effects on post-stroke depression in light of the new hypothesis of depression pathogenesis.