Use of Statins for Secondary Prevention and Primary Prevention of Ischemic Stroke

Numerous randomized, double-blind, placebo-controlled studies and observational studies have shown that statins reduce ischemic stroke in high-risk persons with hypercholesterolemia.The 2013 American College of Cardiology (ACC)/American Heart Association guidelines on treatment of hypercholesterolemia supports the use of statins in 4 major groups.Patients with clinical atherosclerotic cardiovascular disease including those with stroke or transient ischemic attack should be treated with high-dose statins.High-dose statins reduce serum LDL cholesterol ≥50% and include atorvastatin 40 to 80 mg daily and rosuvastatin 20 to 40 mg daily.Patients with a serum LDL cholesterol ≥190 mg/dl should also be treated with high-dose statins.The ACC/AHA guidelines recommend for primary prevention in diabetics with a serum LDL cholesterol between 70 to 189 mg/dl moderate-dose statins.If the 10-year risk of developing atherosclerotic cardiovascular disease (coronary heart disease, stroke, transient ischemic attack, or atherosclerotic peripheral arterial disease) by the Pooled Cohort Equations is ≥7.5%, high-dose statins should be administered.Persons aged 40 to 75 years without atherosclerotic cardiovascular disease or diabetes mellitus with a serum LDL cholesterol between 70 to 189 mg/dl and an estimated 10-year risk of developing atherosclerotic vascular disease of ≥7.5% should be treated with high-dose statins.It is reasonable to treat persons aged 40 to 75 years without atherosclerotic vascular disease or diabetes mellitus with serum LDL cholesterol between 70 to 189 mg/dl and an estimated 10-year risk of developing atherosclerotic cardiovascular disease of 5% to 7.4% with moderate-dose statins.