Statins lower cholesterol by inhibiting HMG-CoA reductase and may play an important role in preventing and treating ischemic stroke beyond cholesterol lowering. Statins impact endothelial dysfunction, thrombogenesis, inflammation, oxidative stress, and angiogenesis, which are processes involved in cerebral ischemic pathogenesis. Pre-stroke statin therapy and acute post-stroke therapy can improve functional outcomes, and discontinuing statins for patients already taking them before stroke may be harmful. Common statin doses used are pravastatin 10-40 mg, atorvastatin 10-80 mg, simvastatin 40 mg, and rosuvastatin 20 mg.

1. T H E R O L E O F S TAT I N S I N S T R O K E
A D E W I J AYA , M D
S E P T E M B E R 2 0 1 8

2. INTRODUCTION
• Stroke is still the third leading cause of death and the most frequent cause of
permanent disability in adults worldwide.
• Systemic and local processes of endothelial dysfunction, thrombogenesis,
inflammatory and oxidative stress damage, and angiogenesis play an important role in
cerebral ischemic pathogenesis and may represent strategic targets for prevention and
treatment of ischemic stroke.
• Statins lower serum cholesterol level by inhibiting hydroxymethylglutaryl-coenzymeA
(HMG-CoA) reductase.
Donnan G.A., Fisher M., Macleod M., Davis S.M. Stroke. Lancet. 2008;371(9624):1612–1623. doi: 10.1016/S0140-6736(08)60694-7.
Dirnagl U., Iadecola C., Moskowitz M.A. Pathobiology of ischaemic stroke: an integrated view. Trends Neurosci. 1999;22(9):391–397. doi: 10.1016/S0166-2236(99)01401-0.
Endo A., Kuroda M., Tsujita Y. ML-236A, ML-236B, and ML-236C, new inhibitors of cholesterogenesis produced by Penicillium citrinium. J. Antibiot. 1976;29(12):1346–1348. doi: 10.7164/antibiotics.29.1346.

3. CHEMICAL STRUCTURE

4. ROLE OF STATINS
BEYOND LOWERING CHOLESTEROL
Zhao J, Zhang X, Dong L, Wen Y, Cui L. The many roles of statins in ischemic stroke. Current neuropharmacology. 2014 Dec 1;12(6):564-74.

5. PATHOPHYSIOLOGY
Zhao J, Zhang X, Dong L, Wen Y, Cui L. The many roles of statins in ischemic stroke. Current neuropharmacology. 2014 Dec 1;12(6):564-74.

6. STATINS DOSE
• Pravastatin 10-40 mg
• Atorvastatin 10-80 mg
• Simvastatin 40 mg
• Rosuvastatin 20 mg
Zhao J, Zhang X, Dong L, Wen Y, Cui L. The many roles of statins in ischemic stroke. Current neuropharmacology. 2014 Dec 1;12(6):564-74.

7. STATINS IN STROKE
• Improved Stroke Functional Outcome with Pre-stroke Therapy
• Improved Functional Outcome with Acute Post-stroke Therapy
• Harmful to discontinue statins if the patient is already taking them before acute
cerebral ischemic stroke
Zhao J, Zhang X, Dong L, Wen Y, Cui L. The many roles of statins in ischemic stroke. Current neuropharmacology. 2014 Dec 1;12(6):564-74.

8. CONCLUSION
• Statins are not only lipid lowering agents but also have pleotrophic effects that may
benefit in stroke prevention.

9. THANK YOU