Recent updates in dyslipidemia management: perspectives in stroke-specific situation

Managing dyslipidemia in stroke is essential. During the past several decades, monumental changes in dyslipidemia management have occurred, resulting in improvement in outcomes of patients with cardiovascular disease (CVD). The mainstay of the changes has been related to statin therapy, which prevents recurrence of vascular events in patients with established CVD. Very recently proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors have introduced a highly efficient level of lipid lowering practice into cardiovascular field. Vast evidence has established and validated the beneficial effects of statin and PCSK-9 inhibitors in CVD. In addition, there have been extensive changes in guidelines pertaining to dyslipidemia management of CVD patients. However, assessing the direct benefits of these agents, specifically and primarily in patients with stroke, has been less of a focus of clinical studies leaving many unanswered questions open. This review covers the current and available evidence and clinical practice guidelines addressing lipid-lowering therapy in stroke. Furthermore, several specific issues related to lipid-lowering therapies in stroke will be addressed such as statin-related risk of hemorrhagic stroke, statin use in non-atherosclerotic stroke subtype, and non-statin lipid-lowering therapies.