Control of dyslipidemia in the prevention of recurrent ischemic cerebrovascular accidents (expert opinion)

Abstract

On July 6, 2022, an interdisciplinary meeting of the Expert Council was held on the topic "Control of dyslipidemia in the prevention of acute and recurrent ischemic cerebrovascular accidents". The conclusion of the Expert Council was that after verification of a lipid metabolism abnormality, in patients with ischemic stroke (IS) and transient ischemic attack (TIA) it is recommended to start or continue statin therapy as early as possible. For secondary prevention of IS, it is necessary to achieve the target level of low-density lipoprotein cholesterol (LDL-C) set for each category of cardiovascular risk, with consistent administration of the maximum tolerated dose of statins with biochemical monitoring of the effectiveness and safety of therapy in the interval of 4–12 weeks. The insufficient effectiveness of statins requires the inclusion of ezetimibe therapy and the decision to increase the dose of statins; in case of intolerance to statins and / or contraindications to their administration, early administration of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors: evolocumab, alirocumab – or an PCSK9 synthesis inhibitor, inclisiran, should be considered. At a LDL-C level of >5.0 mmol/l in patients of the extreme or very high risk group who have had atherothrombotic IS / TIA, necessary administration of a combination including a statin, ezetimibe and an PCSK9 inhibitor (evolocumab, alirocumab) or a PCSK9 synthesis inhibitor (inclisiran) should be considered as early as possible.

Keywords

• dyslipidemia
• ischemic stroke
• transient ischemic attack
• prevention of ischemic stroke
• low-density lipoprotein cholesterol
• lipidlowering therapy
• statins
• pcsk9 inhibitors
• inklisiran