Medicus, Vol. 31 No. 1 Moždani udar, 2022.
Review article
Cholesterol – The Lower the Better?
Marina Roje Bedeković
Abstract
The correlation between serum cholesterol levels to stroke risk is complex and contradictory, and exists in a whole scope of serum levels of total cholesterol, LDL and HDL. Different substances with different action mechanisms, but with a shared goal of lowering serum LDL levels, statins, ezetimibe and PCSK9 inhibitors, reduce the incidence of IS (ischemic stroke), which directly suggests a cause-and-effect link between lowering serum LDL levels and preventing stroke. Warnings of a possible increased risk of hemorrhagic stroke (HS) based on the results of the SPARCL study and a statistically insignificant increase in risk indicated in the IMPROVE-IT and FOURIER results, as well as Cholesterol Treatment Trialist meta-analyses may suggest that a significant reduction in LDL-C could cause HS in a particularly vulnerable subgroup of patients, especially in women and patients with poorly regulated arterial hypertension. As HS is rare compared to IS, concerns about potential increased risk of HS should not overshadow the benefits of LDL-C-lowering drugs and better vascular effects in patients treated with this therapy. It is necessary to determine the stratification of different patient categories in terms of risk factors as well as gender and age, and apply an individual approach and personalised treatment in both primary and secondary prevention of stroke.
Keywords
cholesterol; LDL; HDL; stroke; statins; ezetimibe; PCSK9 inhibitors; women; prevention
Hrčak ID:
275920
URI
Publication date:
2.5.2022.
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