Lipids and Stroke
Lipids and Stroke
Stroke is the third leading cause of death in adults. Although vascular disease is the prime contributor to its pathogenesis, dyslipidaemia is not unambiguously established as a risk factor for stroke in the same way that it is for coronary artery disease. Non-statin treatments of dyslipidaemia have not been shown clearly to help in preventing stroke. However, large clinical trials of treatment with statins over a number of years have demonstrated that these drugs decrease ischaemic stroke rates in persons at risk. Whether this reflects the efficacy of statins in lowering low density lipoprotein-cholesterol (LDL-c) concentrations alone or whether additional mechanisms may apply is not clear.
Stroke is a term that describes a clinical event caused either by occlusion or haemorrhage in the arterial supply to the central nervous system resulting in tissue infarction. It is potentially the most devastating consequence of vascular disease short of death, causing serious long-term disability and incurring extremely high medical, societal and financial costs. Stroke is the commonest cause of death in China and Japan and the third most common in the West, about 1.5 million cases occurring annually in Europe and the USA. It is therefore imperative to acquire a clear understanding of its pathogenesis and to establish what factors determine risk. Stroke is predominantly a disease of ageing, with incidence rates accelerating exponentially above 70 years. The principal additional independent risk factors for stroke are race, gender, hypertension, smoking, diabetes, obesity, pre-existing coronary heart disease (CHD), and atrial fibrillation.
Atheroma lies at the root of the pathogenesis of thromboembolic stroke, extending from the diseased heart, through the atheromatous aorta and carotids to the intracranial circulation. It is therefore to be expected that dyslipidaemia should contribute to the constellation of risk factors for this disease. Surprisingly, this relationship is not clear-cut.
Abstract and Introduction
Abstract
Stroke is the third leading cause of death in adults. Although vascular disease is the prime contributor to its pathogenesis, dyslipidaemia is not unambiguously established as a risk factor for stroke in the same way that it is for coronary artery disease. Non-statin treatments of dyslipidaemia have not been shown clearly to help in preventing stroke. However, large clinical trials of treatment with statins over a number of years have demonstrated that these drugs decrease ischaemic stroke rates in persons at risk. Whether this reflects the efficacy of statins in lowering low density lipoprotein-cholesterol (LDL-c) concentrations alone or whether additional mechanisms may apply is not clear.
Introduction
Stroke is a term that describes a clinical event caused either by occlusion or haemorrhage in the arterial supply to the central nervous system resulting in tissue infarction. It is potentially the most devastating consequence of vascular disease short of death, causing serious long-term disability and incurring extremely high medical, societal and financial costs. Stroke is the commonest cause of death in China and Japan and the third most common in the West, about 1.5 million cases occurring annually in Europe and the USA. It is therefore imperative to acquire a clear understanding of its pathogenesis and to establish what factors determine risk. Stroke is predominantly a disease of ageing, with incidence rates accelerating exponentially above 70 years. The principal additional independent risk factors for stroke are race, gender, hypertension, smoking, diabetes, obesity, pre-existing coronary heart disease (CHD), and atrial fibrillation.
Atheroma lies at the root of the pathogenesis of thromboembolic stroke, extending from the diseased heart, through the atheromatous aorta and carotids to the intracranial circulation. It is therefore to be expected that dyslipidaemia should contribute to the constellation of risk factors for this disease. Surprisingly, this relationship is not clear-cut.
