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Ischemic stroke is a type of
atherosclerotic cardiovascular disease (ASCVD).
Elevated low-density lipoprotein cholesterol (LDL-C) is one of the most important risk factors for the development of
ASCVD.
Numerous studies have confirmed that lowering LDL-C can delay or even reverse the progression of atherosclerosis and reduce the risk of
stroke.
However, the LDL-C compliance rate of stroke patients in China is not ideal
.
A cross-sectional epidemiological survey found that the LDL-C compliance rate of ischemic stroke patients in China was only 27.
4%1
.
In order to better help ischemic stroke patients achieve LDL-C goals and reduce the risk of recurrence and death, Yimaitong invited Professor Xu Anding from the First Affiliated Hospital of Jinan University to conduct an interview to explain the disease characteristics, lipid-lowering treatment goals and strategies
of ischemic stroke patients.
A summary of the interview is as follows
.
- Second-level professor/chief physician, doctoral supervisor, leading medical talent in Guangdong Province
- President of the First Affiliated Hospital of Jinan University, Director of the Cerebrovascular Disease Center
- Expert of the Quality Control Committee of Nervous System Diseases of the National Health Commission
- Vice President of the Chinese Stroke Society
- Member of the Neurology Branch of the Chinese Medical Association and the deputy head of the Cerebrovascular Disease Group
- President of Guangdong Stroke Society
- Vice President of Guangdong Medical Association/Chairman of Neurologist Branch
- In the past ten years, he has been responsible for more than 30 projects such as the National Natural Science Foundation of China and other provincial and ministerial funds, with a total fund of more than 15 million yuan
.
Editor-in-chief, associate editor, co-editor of 6 monographs, and 2 undergraduate textbooks
. - In recent years, the first or corresponding author has published 200+ papers, including more than 90 SCI papers in TOP journals such as Cir Res, Mol Therapy, Stroke, SVN, etc.
, and he has cited 200+ times
in a single article.
Participated in the publication of
2 NEJM papers. - Participated in the formulation of Chinese cerebrovascular disease guidelines and a series of expert consensuses, and presided over the writing
of several expert consensus/guidelines. - Co-editor of "Chinese Guidelines for the Management of Cerebrovascular Diseases 2019" and director of the writing committee
- He has won the second prize of Guangdong Province Science and Technology Progress Award (ranked first), the first prize of Guangxi Autonomous Region Science and Technology Progress Award (ranked second), the "China Stroke Award" of the Chinese Stroke Society, the "Xu Anding Labor Model and Artisan Talent Innovation Studio" of Guangdong Science, Education, Culture and Health Union, and the first "Guangdong Physician Award" of Guangdong Medical Association
Yimaitong:
Atherosclerotic cardiovascular disease (ASCVD) is a serious threat to the health of residents, among which ischemic stroke and coronary heart disease are the most common ASCVD, what are the similarities between the two in disease characteristics and treatment?
Xu Anding
professor
.
Low-density lipoprotein (LDL) enters the lining, deposits in the artery walls and forms atherosclerotic plaques, causing the lumen to narrow and reducing or even blocking the blood supply
to vital organs.
A large number of scientific studies have repeatedly confirmed that elevated low-density lipoprotein cholesterol (LDL-C) is one of the most important pathogenic risk factors for the development of
ASCVD.
Therefore, authoritative guidelines and evidence-based evidence at home and abroad consistently recommend that lipid-lowering therapy is one of the important cornerstones of secondary prevention of ASCVD, and reducing LDL-C levels can reduce cardiovascular and cerebrovascular events, recurrence and death
.
(Click the video to watch for details).
Yimaitong:
Lipid-lowering therapy is one of the important cornerstones of secondary prevention of ASCVD, and the current treatment target value of lipid management is decreasing year by year, especially for ischemic stroke patients, how should the target value of LDL-C be set?
Xu Anding
professor
.
However, for ischemic stroke, the current evidence is that the LDL-C target is <1.
8 mmol/L, and if coronary heart disease is complicated or defined as a very high-risk patient, < 1.
4 mmol/L can also be considered as the LDL-C target
value.
(Click the video to watch for details) Yimaitong: You just mentioned" A lower LDL-C is better", so what intervention do clinicians need to choose to help patients with ischemic stroke better lower LDL-C levels?
Xu Anding
professor
current lipid-lowering therapy.
However, after doubling the statin dose, a further reduction in LDL-C was only about 6%.
Therefore, in addition to statin therapy, if the patient does not meet the LDL-C target or is intolerant, consider increasing cholesterol absorption inhibitors; If the patient is still not up to standard, consider increasing the PCSK9 inhibitor.
In addition, some recent small observational studies have confirmed that very high-risk patients can also directly use PCSK9 inhibitors to reduce cardiovascular and cerebrovascular events, and can also get more benefits
.
(Click the video to watch for details).
References:1.
Wang CJ, et al.
CNS Neurosci Ther 2016; 22(7):577-583
