Standardized lipid management for ischemic stroke (IS) patients, early achievement of target levels, and long-term compliance of LDL-C levels are essential to reduce the risk of stroke recurrence. The Scientific Statement on the Long-term Management of Blood Lipids in Patients with Ischemic Stroke and Transient Ischemic Attack in China elaborates on the long-term blood lipid management, long-term blood lipid monitoring and blood lipid management of key patients with IS and transient ischemic attack (TIA), and puts forward the following recommendations for the management of blood lipids in patients with major IS and TIA.
Long-term lipid management
1. Formulation of the initial treatment plan
- The target value of low-density lipoprotein cholesterol (LDL-C) is determined according to the risk stratification, and patients with atherosclerotic IS/TIA are considered to be very high or very high risk. The target lipid-lowering target value in very high-risk patients was LDL-C <1.8 mmol/L (70 mg/dL) with a ≥50% reduction from baseline (class I recommendation, level A evidence); In ultra-high-risk patients, the target lipid reduction target was LDL-C <1.4 mmol/L (55 mg/dL) with a ≥50% reduction from baseline to reduce the risk of stroke and cardiovascular events (category II.a recommendation, level C evidence).
- Initial treatment is determined based on baseline LDL-C levels, and high-intensity statins are expected to reduce LDL-C to target levels with high-intensity statin therapy (Class I recommendation, Level A evidence); Statins in combination with other lipid-lowering drugs, including cholesterol absorption inhibitors (class I recommendation, level A evidence) and/or PCSK9 inhibitor therapy, are not expected to meet the target, and treatment with statins in combination with other lipid-lowering drugs, including cholesterol absorption inhibitors (class I recommendation, level A evidence).
2. Development of maintenance treatment plan
- Depending on the initial regimen, patients who are able to achieve LDL-C goals continue their current regimen, and those who do not meet the goals are recommended to use the maximum tolerated dose of statins in combination with cholesterol absorption inhibitors (class I recommendation, level B evidence) and/or PCSK9 inhibitors (class II.a recommendation, class B evidence).
- In patients with statin intolerance or contraindications to statin use, subsequent lipid-lowering therapy recommends switching to a non-statin lipid-lowering agent, such as a cholesterol absorption inhibitor or a PCSK9 inhibitor (category II.b recommendation, level B evidence).
3. Long-term adherence to the treatment plan
Improving patient compliance requires the joint efforts of clinicians and patients, starting from the perspective of individualized treatment, reducing patients' LDL-C to the target range as soon as possible, and maintaining the proportion of LDL-C target time, so as to reduce the occurrence of adverse events and bring more clinical benefits.
Focus on lipid management in patients with IS and TIA
1. Endovascular therapy for postoperative blood lipid management
- LDL-C < 1.4 mmol/L and non-HDL-C < 2.2 mmol/L are recommended for patients with IS or TIA who have undergone acute endovascular therapy or carotid endarterectomy/stenting (2.4 mmol/L for non-HDL-C for patients with IS or TIA with symptomatic intracranial and extracranial arterial ste≥nosis (70% intracranial artery stenosis or carotid artery stenosis ≥50%).
Lipid management in patients with diabetes mellitus in 2.IS and TIA
- 对于合并糖尿病的IS或TIA患者，LDL-C应控制在＜1.4 m mo l / L（Ⅱa类推荐，C级证据）。
- For patients with IS or TIA and diabetes mellitus, if there is an increase in TG despite LDL-C achievement or non-HDL-C is not met, consider reducing TG levels with fibrates (category II.b recommendation, level C evidence).
Lipid management in patients with 3.IS and TIA and familial hypercholesterolemia (FH).
- 成人FH伴IS/TIA及其他动脉粥样硬化性心血管疾病（ASCVD）危险因素者，LDL-C靶目标值应＜1.4 mmol/L（Ⅱa类推荐，B级证据）。
- Children and adolescents (< 1 to 8 years of age) with FH and clinical ASCVD (including IS/TIA) should have a target LDL-C target of 1.8 mmol/L < 50% reduction from baseline ≥ (category II.a recommendation, level C evidence).
The above content is sourced: Medical Quality Management and Promotion Branch of Chinese Stroke Society, "Scientific Statement on Long-term Management of Blood Lipids in Chinese Patients with Ischemic Stroke and Transient Ischemic Attack". Chinese Journal of Stroke,2024,19(04):440-451.)
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