Daniel G Hackam1,2,3, Robert A Hegele4. 1. Division of Clinical Pharmacology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, Room 100K-2, Siebens Drake Bldg, 1400 Western Rd, London, Ontario, N6G 2V2, Canada. dhackam@uwo.ca. 2. Department of Epidemiology and Biostatistics, Western University, London, Canada. dhackam@uwo.ca. 3. Department of Clinical Neurological Sciences, Western University, London, Canada. dhackam@uwo.ca. 4. Division of Endocrinology and Metabolism, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada.
Abstract
PURPOSE OF REVIEW: We reviewed lipid-modifying therapies and the risk of stroke and other cerebrovascular outcomes, with a focus on newer therapies. RECENT FINDINGS: Statins and ezetimibe reduce ischemic stroke risk without increasing hemorrhagic stroke risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors similarly reduce ischemic stroke risk in statin-treated patients with atherosclerosis without increasing hemorrhagic stroke, even with very low achieved low-density lipoprotein cholesterol levels. Icosapent ethyl reduces the risk of total and first ischemic stroke in patients with established cardiovascular disease or diabetes mellitus. Clinical outcome trials are underway for newer lipid-modifying agents, including inclisiran, bempedoic acid, and pemafibrate. New biologic agents including evinacumab, pelacarsen, olpasiran, and SLN360 are also discussed. In addition to statins and ezetimibe, PCSK9 inhibitors and icosapent ethyl reduce the risk of ischemic stroke without increasing the risk of hemorrhagic stroke. These therapies dramatically expand options for reducing stroke in high-risk settings.
PURPOSE OF REVIEW: We reviewed lipid-modifying therapies and the risk of stroke and other cerebrovascular outcomes, with a focus on newer therapies. RECENT FINDINGS: Statins and ezetimibe reduce ischemic stroke risk without increasing hemorrhagic stroke risk. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors similarly reduce ischemic stroke risk in statin-treated patients with atherosclerosis without increasing hemorrhagic stroke, even with very low achieved low-density lipoprotein cholesterol levels. Icosapent ethyl reduces the risk of total and first ischemic stroke in patients with established cardiovascular disease or diabetes mellitus. Clinical outcome trials are underway for newer lipid-modifying agents, including inclisiran, bempedoic acid, and pemafibrate. New biologic agents including evinacumab, pelacarsen, olpasiran, and SLN360 are also discussed. In addition to statins and ezetimibe, PCSK9 inhibitors and icosapent ethyl reduce the risk of ischemic stroke without increasing the risk of hemorrhagic stroke. These therapies dramatically expand options for reducing stroke in high-risk settings.
Authors: Deepak L Bhatt; P Gabriel Steg; Michael Miller; Eliot A Brinton; Terry A Jacobson; Steven B Ketchum; Ralph T Doyle; Rebecca A Juliano; Lixia Jiao; Craig Granowitz; Jean-Claude Tardif; Christie M Ballantyne Journal: N Engl J Med Date: 2018-11-10 Impact factor: 91.245
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