The role of cholesterol and statins in stroke

Flawed observational studies find weak associations between high cholesterol and ischemic stroke, and low cholesterol and hemorrhagic stroke. Low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides each appear to have individual effects on stroke risk and type. Statins decrease the risk of cerebral infarction in patients with coronary disease, diabetes, hypertension, and hypercholesterolemia. They also significantly decrease the risk of ischemic stroke in patients with recent cerebrovascular disease, while potentially increasing the risk of intracerebral hemorrhage. Lower achieved cholesterol values are associated with greater reductions in stroke risk. Besides their cholesterol-lowering properties, statins are also pleiotropic agents with various neuroprotective mechanisms. Neurologic disability and infarct size are decreased in patients administered statins during stroke. Mortality and neurologic deterioration are higher in patients with statin cessation during acute ischemic stroke. Cholesterol is a modifiable risk factor for stroke, and statins are excellent agents for prophylaxis and acute therapy.