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An introduction to the importance of cholesterol-lowering therapy in reducing the risk of ischemic stroke/transient ischemic attack (TIA)
.
The "Guiding Standards for the Management of Blood Lipids in the Prevention and Treatment of Stroke" aims to guide medical staff in the rational management of blood lipids and scientifically prevent and treat strokes through the compilation and analysis of domestic and foreign management guidelines for dyslipidemia and the latest research, combined with China's national conditions and clinical status
.
1 Blood lipid management in the acute phase of ischemic stroke 1.
Patients with ischemic stroke who have taken statins for lipid-lowering or anti-atherosclerosis treatment before the onset of the disease should continue to take it in the acute phase
.
2.
For patients with ischemic stroke who have not taken statins before the onset, it is recommended to start statin therapy in the hospital as soon as possible, but more evidence is needed to support it
.
2 Blood lipid management for secondary prevention of ischemic stroke ➤ Life>
.
2.
For patients with non-cardiac ischemic stroke/TIA, long-term use of statins can prevent the recurrence of ischemic stroke/TIA
.
3.
Once a patient is diagnosed with ischemic stroke/TIA, they are all at high risk of ASCVD.
Regardless of whether the cause is atherosclerosis and whether the cholesterol level is normal, statin therapy is recommended to reduce the risk of recurrence of vascular events
.
➤The lipid-lowering target value of ischemic stroke 1.
For non-cardiogenic ischemic stroke/TIA patients, regardless of other evidence of atherosclerosis, long-term treatment with statins is recommended to reduce the brain The risk of stroke and cardiovascular events; the recommended target value of LDL-C is less than 1.
8mmol/L (70mg/dl) or at least reduced by 50%
.
If the baseline LDL-C has reached the target value, it is still necessary to further reduce LDL-C by 30%
.
2.
Clinically, start the application of moderate-intensity statins based on the patient's baseline blood lipid level, and adjust the dose appropriately according to the individual's lipid-lowering efficacy and tolerance.
If the cholesterol level is not up to standard, use it in combination with other lipid-lowering drugs to obtain a safe and effective adjustment.
Fat effect
.
3.
If after treatment with the maximum tolerated dose of statin and ezetimibe, the LDL-C level is still ≥70mg/dl (1.
8mmol/L), the addition of pre-protein PCSK9 inhibitor is reasonable, but long-term (>3 Years) The safety of use has not yet been determined
.
3 Blood lipid management for special populations with ischemic stroke ➤ Diabetic patients 1.
Patients with ischemic stroke and diabetes, regardless of their baseline LDL-C level, should undergo life>
.
2.
For patients with ischemic stroke and diabetes, regardless of their baseline LDL-C level, statin lipid-lowering therapy is the first choice, and the target value of LDL-C treatment is less than 70 mg/dl (1.
8 mmol/L)
.
3.
After moderate-intensity statin treatment, LDL-C still does not meet the standard, you can use other types of lipid-lowering drugs combined with statin treatment to achieve LDL-C standard
.
➤Patients with liver disease or abnormal liver function 1.
For patients with ischemic stroke with a history of hepatitis, cirrhosis or other liver damage, statins can be considered on the basis of evaluating the benefit-risk ratio, and combined if necessary Apply liver protection drugs
.
Patients with active liver disease or persistently elevated transaminases should temporarily stop statins
.
2.
Liver function and muscle enzymes must be monitored during drug treatment.
If AST/ALT exceeds 3 times the upper limit of normal, the administration should be suspended, and liver function should be reviewed every week after stopping the drug until it is normal
.
When liver enzymes are normal, consider retrying small doses of original statins or other lipid-lowering drugs
.
4 Management of blood lipids in patients with hemorrhagic stroke For patients with ischemic stroke with a history of cerebral hemorrhage, statins should be used rationally after weighing the risks and benefits
.
The above content is extracted from: Medical Administration and Hospital Administration.
Chinese Guidelines for Stroke Prevention and Treatment (2021 Edition)-4.
Chinese Guidelines for the Management of Blood Lipids in the Prevention and Treatment of Stroke.
2021-8-31.
.
The "Guiding Standards for the Management of Blood Lipids in the Prevention and Treatment of Stroke" aims to guide medical staff in the rational management of blood lipids and scientifically prevent and treat strokes through the compilation and analysis of domestic and foreign management guidelines for dyslipidemia and the latest research, combined with China's national conditions and clinical status
.
1 Blood lipid management in the acute phase of ischemic stroke 1.
Patients with ischemic stroke who have taken statins for lipid-lowering or anti-atherosclerosis treatment before the onset of the disease should continue to take it in the acute phase
.
2.
For patients with ischemic stroke who have not taken statins before the onset, it is recommended to start statin therapy in the hospital as soon as possible, but more evidence is needed to support it
.
2 Blood lipid management for secondary prevention of ischemic stroke ➤ Life>
.
2.
For patients with non-cardiac ischemic stroke/TIA, long-term use of statins can prevent the recurrence of ischemic stroke/TIA
.
3.
Once a patient is diagnosed with ischemic stroke/TIA, they are all at high risk of ASCVD.
Regardless of whether the cause is atherosclerosis and whether the cholesterol level is normal, statin therapy is recommended to reduce the risk of recurrence of vascular events
.
➤The lipid-lowering target value of ischemic stroke 1.
For non-cardiogenic ischemic stroke/TIA patients, regardless of other evidence of atherosclerosis, long-term treatment with statins is recommended to reduce the brain The risk of stroke and cardiovascular events; the recommended target value of LDL-C is less than 1.
8mmol/L (70mg/dl) or at least reduced by 50%
.
If the baseline LDL-C has reached the target value, it is still necessary to further reduce LDL-C by 30%
.
2.
Clinically, start the application of moderate-intensity statins based on the patient's baseline blood lipid level, and adjust the dose appropriately according to the individual's lipid-lowering efficacy and tolerance.
If the cholesterol level is not up to standard, use it in combination with other lipid-lowering drugs to obtain a safe and effective adjustment.
Fat effect
.
3.
If after treatment with the maximum tolerated dose of statin and ezetimibe, the LDL-C level is still ≥70mg/dl (1.
8mmol/L), the addition of pre-protein PCSK9 inhibitor is reasonable, but long-term (>3 Years) The safety of use has not yet been determined
.
3 Blood lipid management for special populations with ischemic stroke ➤ Diabetic patients 1.
Patients with ischemic stroke and diabetes, regardless of their baseline LDL-C level, should undergo life>
.
2.
For patients with ischemic stroke and diabetes, regardless of their baseline LDL-C level, statin lipid-lowering therapy is the first choice, and the target value of LDL-C treatment is less than 70 mg/dl (1.
8 mmol/L)
.
3.
After moderate-intensity statin treatment, LDL-C still does not meet the standard, you can use other types of lipid-lowering drugs combined with statin treatment to achieve LDL-C standard
.
➤Patients with liver disease or abnormal liver function 1.
For patients with ischemic stroke with a history of hepatitis, cirrhosis or other liver damage, statins can be considered on the basis of evaluating the benefit-risk ratio, and combined if necessary Apply liver protection drugs
.
Patients with active liver disease or persistently elevated transaminases should temporarily stop statins
.
2.
Liver function and muscle enzymes must be monitored during drug treatment.
If AST/ALT exceeds 3 times the upper limit of normal, the administration should be suspended, and liver function should be reviewed every week after stopping the drug until it is normal
.
When liver enzymes are normal, consider retrying small doses of original statins or other lipid-lowering drugs
.
4 Management of blood lipids in patients with hemorrhagic stroke For patients with ischemic stroke with a history of cerebral hemorrhage, statins should be used rationally after weighing the risks and benefits
.
The above content is extracted from: Medical Administration and Hospital Administration.
Chinese Guidelines for Stroke Prevention and Treatment (2021 Edition)-4.
Chinese Guidelines for the Management of Blood Lipids in the Prevention and Treatment of Stroke.
2021-8-31.
