Intensive lowering of LDL cholesterol with statin-based therapies in people with a history of ischaemic stroke reduces recurrence and should be recommended when patients have atherosclerosis, researchers say.

For those without atherosclerosis, however, the net benefit is less clear given an increased risk of haemorrhagic stroke and new-onset type 2 diabetes, according to findings from a meta-analysis.  

The study included 11 randomised clinical trials covering more than 20,000 patients with a history of ischaemic stroke (median age 64.9 years; 67% men), who were followed up for a median of four years.

It found intensive treatment with statin-based therapies was linked to a 12% reduced risk of recurrent stroke and 17% reduced risk of major adverse cardiovascular events (MACE), with no statistically significant difference in results from strategies that incorporated ezetimibe or PCSK9 inhibitor therapy.