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MANAGEMENT OF HYPERLIPIDEMIA AND STROKE

BACKGROUND Hyperlipidemia is associated with coronary heart disease (CHD) and stroke and is a widespread problem. There is emerging evidence that cholesterol‐modifying agents can reduce the risk of stroke, making this a topic of interest for neurologists. REVIEW SUMMARY Reducing cholesterol with agents other than 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) has not been shown to lessen the incidence of ischemic stroke. Primary prevention using statin agents has not been beneficial in reducing the risk of stroke, but it does reduce CHD. In patients who have CHD, the use of statins has been associated with decreased incidence of ischemic stroke. The mechanisms of stroke reduction may include lipid‐lowering or anti‐atherothrombotic effects. Statins generally are safe and well tolerated. Dosing and side effects are reviewed. CONCLUSIONS Statin agents should be prescribed by neurologists for stroke prevention in patients who have a history of CHD. Statin use could reasonably be recommended in ischemic stroke patients who have vascular risk factors. Age and cholesterol levels should be carefully considered before starting a statin in the care of stroke patients. (THE NEUROLOGIST 6:160‐170, 2000)