Eficacia de la terapia con estatinas para la prevencion primaria y secundaria de accidente cerebrovascular isquemico, revision y evidencia cientifica disponible

Background and objectives: To assess the effect of statin-based lipid-lowering therapy in ischemic stroke in primary and secondary prevention trials with respect to low-density lipoprotein cholesterol levels achieved in view of the availability of new potent lipid-lowering agents.Methods: the most up-to-date and available publications were searched in the English literature (until 2018).Results: Lipid-lowering therapy was associated with a lower risk of ischemic stroke in primary prevention (hazard ratio, RR, 0.70; 95% confidence interval, CI, 0.60–0.82; P < 0.001). and in secondary prevention (RR 0.80, 95% CI 0.70-0.90, p < 0.001). The curve estimation procedure revealed a linear relationship between absolute risk reduction of ischemic stroke and active treatment, achieving guideline-adjusted low-density lipoprotein cholesterol levels in secondary prevention (adjusted R-squared 0, 90) in support of the "lower is better" hypothesis for stroke survivors. On the other hand, the cubic model followed well the data observed in primary prevention (adjusted R-squared 0.98), indicating a greater absolute risk reduction in individuals free of cardiovascular disease.Conclusions: Statin-based lipid-lowering drugs are effective for both primary and secondary prevention of ischemic stroke. Most of the benefit derives from targeting disease-free individuals at high cardiovascular risk and achieving adequate treatment goals for low-density lipoprotein levels in primary prevention and stroke survivors.