Consensus statement and clinical recommendations on the practical management of lipid-lowering therapy in stroke and transient ischaemic attack

Abstract

Background

Stroke represents a major public health challenge in Spain, with approximately 120 000 cases per year and a significant impact on mortality, disability, and dependency. Elevated low-density lipoprotein cholesterol (LDL-C) is a key modifiable causal factor in preventing vascular recurrences. This consensus statement aims to provide a comprehensive framework for the practical management of lipid-lowering therapy in patients with stroke or transient ischaemic attack (TIA).

Methods

A panel of experts in neurology, specialised in the management of patients with stroke/TIA, participated in 3 sessions to review the latest evidence. Subsequently, they reached consensus on practical recommendations for the management of lipid-lowering therapy based on data from clinical trials, meta-analyses, and current clinical guidelines.

Conclusions

Achieving the therapeutic targets for LDL-C is essential to prevent recurrence in patients with stroke/TIA. To ensure comprehensive management of LDL-C in patients with stroke/TIA, the application of intensive therapeutic strategies, individualised approaches, and robust continuity of care are recommended to optimise secondary prevention. Treatment planning at discharge, neurologist-led risk factor control, and coordinated continuity of care between hospital and primary care settings are essential factors determining long-term outcomes. Inclisiran has emerged as a new key therapy to improve lipid control and treatment adherence in these patients, in alignment with national and international recommendations for achieving therapeutic targets and reducing the burden of vascular disease. Optimal implementation of this therapeutic approach may substantially contribute to improving the prognosis of patients with stroke/TIA.