Beyond statin monotherapy

초록

Stroke is one of atherosclerotic disease and major cause of death in Korea and Japan. Taking into account population ageing, stroke death rates are decreasing steadily globally. Previous statin trials suggest that aggressive LDL lowering by statin is important for stroke prevention. Current guidelines recommend that LDL levels of the patients with ischemic stroke is controlled below 70 mg/dL or over 50% reduction from baseline by intense potent statins. However,some patients continue to suffer stroke and coronary events, even after reduction of LDL to conventional goals. Sometimes, patients have not reached target LDL levels on maximal statin doses. Optimization of triglycerides and HDL and other kinds of medication for LDL reduction have been proposed for strategy to decrease this residual risk. But these agents such as niacin and omega-3 fatty acids, have not been shown to improve clinical outcomes and carries an considerable risk of adverse events. Ezetimibe is cholesterol absorption inhibitor and has complementary mechanism of action during statin combination medication. Recent Report(IMPROVE-IT) about combination of ezetimibe and simvastatin is the first trial, demonstrating incremental clinical benefit when adding a non-statin agent to statin therapy. Long term lipid management with ezetimibe and statin combination has benefited reducing the cardiovascular events, especially ischemic stroke with acceptable side effect. In this session, we review the effects and safety profile of lipid modifying agents and new agents including ezetimbe and PCSK9 inhibitors. In addition, we will present several cased like the proper LDL level during anticoagulation and the bleeding risk during potent statin medication in stroke patients.