Statin for secondary stroke prevention:

UptoDate article

Statin therapy —
= For hyperlipidemia, statins decreases the risk of stroke
- lipid lowering by other means (eg, fibrates, resins, diet) has no significant impact on stroke incidence
- Statins may have anti-atherothrombotic properties
- May have a role in plaque stabilization, reducing inflammation, slowing carotid arterial disease progression, improving endothelial function, and reducing embolic stroke by prevention of myocardial infarction and left ventricular dysfunction.

For patients with TIA or ischemic stroke of atherosclerotic origin
= if able to tolerate statins
= Recommend high-intensity statin therapy, independent of the baseline low-density lipoprotein cholesterol (LDL-C)
= Atorvastatin 80 mg/day, was the agent and dose used in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial that showed a benefit for secondary ischemic stroke prevention.

Unable to tolerate one statin because of myopathy
= try another statin that may be better tolerated or
= try alternative dosing regimens, such as giving the drug every other day
= Use a low doses of rosuvastatin

LDL-C still over 70 with maximal doses of atorvastatin or rosuvastatin
= Check compliance with medication
= Life style modification
= Consider adding ezetimibe
= Last resort PCSK9 antibody

Management of LDL-C

High-intensity statin therapy (≥50 percent LDL-C reduction) includes daily treatment with:
●Atorvastatin 40 to 80 mg
●Rosuvastatin 20 to 40 mg.

Moderate-intensity statin therapy (30 to 50 percent LDL-C reduction) includes
●Lovastatin 40 mg
●Pravastatin 40 mg
●Simvastatin 40 mg
●Atorvastatin 10 to 20 mg
●Rosuvastatin 5 to 10 mg
●Pitavastatin 4 mg