Statins in Acute Ischemic Stroke: Mechanisms, Resistance, and Precision Strategies for Neurovascular and Cognitive Protection

GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global burden of disease study 2021. Lancet Neurol. 2024;23(10):973–1003. https://doi.org/10.1016/s1474-4422(24)00369-7.

Article  Google Scholar 

Biswas R, Wijeratne T, Zelenak K, Huasen BB, Iacobucci M, Killingsworth MC, et al. Disparities in access to reperfusion therapy for acute ischemic stroke (DARTS): a comprehensive meta-analysis of ethnicity, socioeconomic status, and geographical factors. CNS Drugs. 2025;39(4):417–42. https://doi.org/10.1007/s40263-025-01161-z.

Article  PubMed  Google Scholar 

GBD 2021 Nervous System Disorders Collaborators. Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global burden of Disease study 2021. Lancet Neurol. 2024;23(4):344–81. https://doi.org/10.1016/s1474-4422(24)00038-3.

Article  Google Scholar 

Lv W, Wang A, Wang Q, Wang R, Xu Q, Wu S, et al. One-year direct and indirect costs of ischaemic stroke in China. Stroke Vasc Neurol. 2024;9(4):380–9. https://doi.org/10.1136/svn-2023-002296.

Article  PubMed  Google Scholar 

Strilciuc S, Grad DA, Radu C, Chira D, Stan A, Ungureanu M, et al. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life. 2021;14(5):606–19. https://doi.org/10.25122/jml-2021-0361.

Article  PubMed  PubMed Central  Google Scholar 

Li C, Spencer G, Husain MJ, Nugent R, Auzenne D, Kostova D, et al. Barriers to accessibility of medicines for hyperlipidemia in low- and middle-income countries. PLoS Glob Public Health. 2024;4(2):e0002905. https://doi.org/10.1371/journal.pgph.0002905.

Article  PubMed  PubMed Central  Google Scholar 

Anand A, Hegde NC, Chhabra P, Purohit J, Kumar R, Gupta A, et al. Pharmacogenetic guided versus standard warfarin dosing for routine clinical care with its pharmacoeconomic impact: a randomized controlled clinical trial. Ann Hematol. 2024;103(6):2133–44. https://doi.org/10.1007/s00277-024-05757-1.

Article  PubMed  CAS  Google Scholar 

Phipps MS, Cronin CA. Management of acute ischemic stroke. Br Med J. 2020;368:l6983. https://doi.org/10.1136/bmj.l6983.

Article  Google Scholar 

Okada T, Suzuki H, Travis ZD, Zhang JH. The stroke-induced blood-brain barrier disruption: current progress of inspection technique, mechanism, and therapeutic target. Curr Neuropharmacol. 2020;18(12):1187–212. https://doi.org/10.2174/1570159x18666200528143301.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Rudd A, Le TN, Nguyen NH. Stroke management in Vietnam. 1 ed. Key considerations for the implementation of healthcare services. Singapore: Springer; 2024. https://doi.org/10.1007/978-981-96-0221-6.

Lanctôt KL, Lindsay MP, Smith EE, Sahlas DJ, Foley N, Gubitz G, et al. Canadian stroke best practice recommendations: mood, cognition and fatigue following stroke, 6th edition update 2019. Int J Stroke. 2020;15(6):668–88. https://doi.org/10.1177/1747493019847334.

Article  PubMed  Google Scholar 

He Z, Sun J. The role of the neurovascular unit in vascular cognitive impairment: current evidence and future perspectives. Neurobiol Dis. 2025;204:106772. https://doi.org/10.1016/j.nbd.2024.106772.

Article  PubMed  CAS  Google Scholar 

Taylor F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013(1). https://doi.org/10.1002/14651858.CD004816.pub5.

Feigin VL, Owolabi MO. Pragmatic solutions to reduce the global burden of stroke: a World Stroke Organization-Lancet Neurology Commission. Lancet Neurol. 2023;22(12):1160–206. https://doi.org/10.1016/s1474-4422(23)00277-6.

Article  PubMed  PubMed Central  Google Scholar 

Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017;120(1):229–43. https://doi.org/10.1161/circresaha.116.308537.

Article  PubMed  PubMed Central  CAS  Google Scholar 

German CA, Liao JK. Understanding the molecular mechanisms of statin pleiotropic effects. Arch Toxicol. 2023;97(6):1529–45. https://doi.org/10.1007/s00204-023-03492-6.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Libby P, Aikawa M. Stabilization of atherosclerotic plaques: new mechanisms and clinical targets. Nat Med. 2002;8(11):1257–62. https://doi.org/10.1038/nm1102-1257.

Article  PubMed  CAS  Google Scholar 

Khatiwada N, Hong Z. Potential benefits and risks associated with the use of statins. Pharmaceutics. 2024;16(2):214. https://doi.org/10.3390/pharmaceutics.16020214.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Shahid MS, Bourgleh MS, Alharfi A, Albariqi S, Albalawi L, Alohali R, et al. High-dose statins for the prevention of recurrent ischemic stroke: a systematic review and meta-analysis of randomized controlled trials. Ann Saudi Med. 2025;45(2):112–28. https://doi.org/10.5144/0256-4947.2025.112.

Article  PubMed  Google Scholar 

Bach F, Skajaa N, Esen BO, Fuglsang CH, Horváth-Puhó E, Sørensen HT, et al. High-intensity versus moderate-intensity statin treatment for patients with ischemic stroke: nationwide cohort study. Eur Stroke J. 2023;8(4):1041–52. https://doi.org/10.1177/23969873231193288.

Article  PubMed  PubMed Central  Google Scholar 

Bao J, Zhang Y, Li Y, Guo J, He L. Low-to-moderate dose statins improve the functional outcome of acute ischemic stroke with conventional medication treatment. Cardiovasc Diagn Ther. 2023;13(4):686–99. https://doi.org/10.21037/cdt-23-77.

Article  PubMed  PubMed Central  Google Scholar 

Choi SE, Bucci T, Huang JY, Yiu KH, Tsang CT, Lau KK, et al. Early statin use is associated with improved survival and cardiovascular outcomes in patients with atrial fibrillation and recent ischaemic stroke: a propensity-matched analysis of a global federated health database. Eur Stroke J. 2024;10(1):116–27. https://doi.org/10.1177/23969873241274213.

Article  PubMed  PubMed Central  Google Scholar 

Cui C, Dong S, Liu Q, Bao J, Gao L, Li Y, et al. Low-dose statins improve prognosis of patients with ischaemic stroke undergoing intra-arterial thrombectomy: a prospective cohort study. J Clin Neurosci. 2022;103:124–30. https://doi.org/10.1016/j.jocn.2022.07.001.

Article  PubMed  CAS  Google Scholar 

Cui C, Li Y, Bao J, Dong S, Gao L, He L. Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis. BMC Neurol. 2021;21(1):220. https://doi.org/10.1186/s12883-021-02259-9.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Dearborn-Tomazos JL, Hu X, Bravata DM, Phadke MA, Baye FM, Myers LJ, et al. Deintensification or no statin treatment is associated with higher mortality in patients with ischemic stroke or transient ischemic attack. Stroke. 2021;52(8):2521–9. https://doi.org/10.1161/STROKEAHA.120.030089.

Article  PubMed  CAS  Google Scholar 

Fan H, Wang Y, Zhang K, Liu T, Li X, Li Y, et al. Intensive versus moderate statin-based therapies in patients with mild ischemic stroke: a prospective multicenter cohort study. J Am Heart Assoc. 2024;13(14):e035337. https://doi.org/10.1161/JAHA.124.035337.

Article  PubMed  PubMed Central  CAS  Google Scholar 

Gao Y, Jiang L, Pan Y, Chen W, Jing J, Wang C, et al. Immediate- or delayed-intensive statin in acute cerebral ischemia: the INSPIRES randomized clinical trial. JAMA Neurol. 2024;81(7):741–51. https://doi.org/10.1001/jamaneurol.2024.1433.

Article  PubMed  PubMed Central  Google Scholar 

Gong C, Liu C, Wang Y, Chen L, Yuan J, Zhang J, et al. Effect of statin treatment on clinical outcomes in cardioembolic stroke with endovascular thrombectomy. J Neurointerv Surg. 2024;16(9):947–54. https://doi.org/10.1136/jnis-2023-020619.

Article  PubMed  Google Scholar 

Kim JT, Lee JS, Kim BJ, Kang J, Lee KJ, Park JM, et al. Statin treatment in patients with stroke with low-density lipoprotein cholesterol levels below 70 mg/dL. J Am Heart Assoc. 2023;12(18):e030738. https://doi.org/10.1161/jaha.123.030738.

Article  PubMed  PubMed Central  CAS 

Comments (0)

No login
gif