CNS drugs

How Statins May Protect Brain Blood Vessels and Thinking After Stroke: Causes of Resistance and Tailored Treatments

Updated

Abstract

Acute ischemic stroke (AIS) survivors face high risks of recurrent stroke and cognitive decline.

  • Statins have lipid-lowering effects and may also provide anti-inflammatory and neuroprotective benefits in AIS management.
  • Challenges to statin effectiveness include variability in patient responses and limited availability in the central nervous system.
  • Innovative strategies, such as pharmacogenomic-guided therapy and advanced drug delivery systems, could enhance statin efficacy.
  • Combination therapies with PCSK9 inhibitors or SGLT2 inhibitors may offer additional benefits for AIS patients.
  • Adopting precision medicine approaches may improve treatment outcomes for AIS survivors, particularly in low-resource settings.

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Funding

Competing interests

Declarations. Funding: The financial support for a separate project was received through the Grant-in-Aid for Scientific Research (KAKENHI) (principal investigator [PI]: S.M.M.B.), funded by the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Japan (Grant no.: 23KF0126). S.M.M.B was awarded the JSPS International Fellowship, supported by MEXT and the Australian Academy of Science, for the period 2023–2025 (Grant no.: P23712). Conflict of interest: S.M.M.B. reports leadership or a fiduciary role in other board, society, committee, or advocacy group activity, paid or unpaid, with the National Cerebral and Cardiovascular Center (Osaka, Japan) as visiting director (2023–2025); Rotary District 9675 (Sydney, Australia) as district chair for Diversity, Equity, and Inclusion; the Global Health and Migration Hub Community, Global Health Hub Germany (Berlin, Germany) as chair, founding member, and manager; and editorial board memberships at PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research, Neurology International, Diagnostics, and BMC Medical Research Methodology. Additionally, S.M.M.B. serves as a member of the College of Reviewers for the Canadian Institutes of Health Research (CIHR), Government of Canada; director of research for the World Headache Society (Bengaluru, India); a member of the Scientific Review Committee at Cardiff University Biobank (Cardiff, UK); chair of the Rotary Reconciliation Action Plan (RAP), Rotary District 9675 (NSW, Australia); healthcare and medical adviser for the Japan Connect (Osaka, Japan); and as an expert adviser/reviewer for the Cariplo Foundation (Milan, Italy). These roles are unrelated to the submitted work. Other authors (M.G., K.J.S., I.S., D.M., M.M.M., and R.G.B.) report no conflicts of interest. The funding body has had no role in the study design, data collection, analysis, interpretation of findings, and manuscript preparation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the affiliated/funding organization/s. Availability of data and material: The original contributions presented in the study are included in the article. Further inquiries can be directed at the corresponding author. Ethics approval: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable. Code availability: Not applicable. Authors’ contributions: S.M.M.B. conceived the study and contributed to its planning, drafting, and revision while supervising the Global Health Neurology Lab members. S.M.M.B. is the principal investigator for the Impact of Statin Therapy on the Risk of Stroke Recurrence, Mortality, and Dementia After Ischemic Stroke (ISMARDD) study. S.M.M.B. encouraged M.G. to investigate the topic and oversaw the synthesis of findings. M.G. and S.M.M.B. contributed to the literature review, data collection, initial draft, manuscript revisions, and overall discussion. K.J.S., I.S., D.G.C., M.M.M., and R.G.B. contributed to initial discussion, validation, intellectual content, and manuscript revisions. S.M.M.B. provided critical revisions, supervised the project, and approved the final manuscript. All authors reviewed and approved the final draft of the manuscript.
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