25 Sept 2023 • The American Heart Association (AHA) released a scientific statement on the impact of aggressive LDL-C lowering on dementia and hemorrhagic stroke risk. Their objective was to evaluate contemporary evidence that either supports or refutes the conclusion that aggressive LDL-C lowering or lipid lowering exerts toxic effects on the brain, leading to cognitive impairment or dementia or hemorrhagic stroke.

The statement concludes:

• LDL-C lowering reduces cardiovascular disease risk in high-risk groups.
• While some studies suggest a link between statins/LDL-C lowering and cognitive issues, most evidence does not support this, at least within 6 years of follow-up. Longer-term studies are needed. Current guidelines for lipid lowering goals are reasonable.
• Statin therapy has a small and insignificant risk of hemorrhagic stroke in patients without a history of cerebrovascular disease.
• PCSK9 inhibitors and ezetimibe don't increase bleeding risk.
• Lower LDL-C levels reduce overall stroke risk, mainly ischemic stroke. Concerns about hemorrhagic stroke should not deter treatment to guideline-recommended targets.
• Data on hemorrhagic stroke risk with statin therapy in patients with a history of hemorrhagic stroke are lacking. More research is needed for lipid lowering in these populations, especially with PCSK9 inhibitors.

Source: AHA | Read full story