UK Stroke Forum 2025 | Managing lipid levels with medication to prevent secondary stroke
Joseph Kwan, MB ChB, MPhil, MD, Charing Cross Hospital, London, UK, discusses the current pharmacological approach to managing lipid levels for secondary stroke prevention. He highlights the use of high-intensity atorvastatin as first-line treatment, with a target low-density lipoprotein (LDL) level below 1.8 mmol/L. While statins are effective, many patients require additional treatment to reach this target. Dr Kwan notes that this includes inclisiran, which can reduce LDL levels by 50-55% with just two maintenance injections per year. This interview took place at the UK Stroke Forum (UKSF) 2025 Conference in Aberdeen, UK.
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Transcript
Yeah, so what we know is lowering your cholesterol reduces your risk of another stroke and heart attacks and peripheral vascular disease in the future. And so at the moment we use atorvastatin as the first line and a high intensity atorvastatin is what usually people get put on when they come in with an acute ischemic stroke. And so we need to reach an LDL, which is the low density lipoprotein, the bad cholesterol, we need to reach a target and reduce the LDL target down to below 1...
Yeah, so what we know is lowering your cholesterol reduces your risk of another stroke and heart attacks and peripheral vascular disease in the future. And so at the moment we use atorvastatin as the first line and a high intensity atorvastatin is what usually people get put on when they come in with an acute ischemic stroke. And so we need to reach an LDL, which is the low density lipoprotein, the bad cholesterol, we need to reach a target and reduce the LDL target down to below 1.8. And when we do that, we know that we can reduce the risk of stroke and heart attacks in the future. And you only need to treat five people to prevent one stroke or heart attack in the future by lowering the cholesterol with high intensity statins. So statins are very important, but most people don’t get to the 1.8 target with just statins. So we need other things in the armor. And so one of the important… another tablet is called ezetimibe. And ezetimibe 10 milligram can lower your cholesterol by another 15-20 percent maximum. But the things which reduce it the most on top of using statins is the injectables. So nowadays we have choice of injectables, but the one which is most convenient to use, which is twice a year, is called Inclisiran. And for that one, you only need to have sustained two maintenance injections per year, and that can reduce your LDL by 50 to 55%. So for that, you have to have a LDL of greater than 2.6 after you’ve had a stroke and on maximal statin dosage. So that’s what we try to do in our clinics.
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