Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines.
Role of Blood Lipid Levels and Lipid-Lowering Therapy in Stroke Patients with Different Levels of Cerebral Artery Diseases: Reconsidering Recent Stroke Guidelines.
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DOI：
10.5853/jos.2021.01249
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发表时间：
2021-05
影响因子：
8.2
通讯作者：
Kim JS
中科院分区：
文献类型：
--
作者：
Kim JS
高脂血症是缺血性脑卒中的一个重要危险因素；强化降低胆固醇水平预防脑卒中（SPARCL）研究和达到目标治疗脑卒中（TST）研究表明，他汀类药物对脑卒中患者有益，且低密度脂蛋白胆固醇（LDL - C）浓度的低目标值可能使这种益处最大化。基于这些结果，近期的指南强调了在脑卒中患者中应用“高强度他汀类药物”和“低LDL - C目标值”策略。然而，应当牢记，在不同脑动脉疾病程度的患者中，血脂作为危险因素的作用以及降脂治疗的益处是不同的。研究表明，低血脂而非高血脂是诸如脑出血、微出血、白质高信号以及可能的腔隙性脑梗死等小血管疾病（SVD）的一个危险因素。尽管降脂药物可能对某些SVD患者有益，但高强度他汀类药物和低LDL - C目标值策略并不适用。相反，考虑到有充分证据表明降脂药物的益处，这些策略在颅外动脉粥样硬化（如颈内动脉疾病）患者中是重要的。影像学研究表明，他汀类药物可稳定这些患者的易损斑块。尽管降脂药物可能对颅内动脉粥样硬化患者有益，但其益处程度以及这些患者合适的LDL - C目标水平仍不清楚。需要更多的研究来阐明在不同脑动脉疾病程度的脑卒中患者中合适的调脂策略。
Hyperlipidemia is an important risk factor for ischemic stroke; the Stroke Prevention by Aggressive Reduction in Cholesterol Level and Treat Stroke to Target studies have shown that statins are beneficial for patients with stroke and that a low target for low-density lipoprotein cholesterol (LDL-C) concentration may maximize this benefit. Based on these results, recent guidelines have emphasized the application of “high-intensity statins” and “low LDL-C target” strategies in patients with stroke. However, it should be kept in mind that the role of blood lipids as a risk factor and benefit of lipid-lowering therapy are different among patients with different levels of cerebral arterial diseases. Studies have suggested that hypolipidemia, but not hyperlipidemia, is a risk factor for small vessel diseases (SVDs) such as intracerebral hemorrhages, microbleeds, white matter hyperintensities, and perhaps, lacunar infarction. Although lipid-lowering agents might benefit certain patients with SVD, high-intensity statin and low LDL-C target strategies cannot be applied. In contrast, these strategies are important in patients with extracranial atherosclerosis, such as internal carotid disease, considering ample evidence of the benefits of lipid-lowering agents. Imaging studies have shown that statins stabilize vulnerable plaques in these patients. Although lipid-lowering agents are likely to benefit patients with intracranial atherosclerosis, the degree of their benefit and appropriate target LDL-C level for these patients remain unclear. More studies are needed to elucidate the appropriate lipid-modifying strategies in patients with stroke with different levels of cerebral artery disease.
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影响因子：
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