What is the role of statin therapy after ischemic stroke?

• A. Secondary prevention to reduce vascular risk and recurrent stroke.
• B. First-line treatment for lowering blood pressure acutely.
• C. Used only if LDL is above target.
• D. Not recommended due to bleeding risk.

Answer: (A)

Statin therapy after an ischemic stroke is primarily about secondary prevention: it lowers the chance of another stroke and other vascular events by reducing atherosclerotic risk. Statins decrease LDL cholesterol and also have plaque-stabilizing, anti-inflammatory, and endothelial benefits that help prevent recurrence. Guidelines recommend starting or continuing high‑intensity statin therapy in most patients after ischemic stroke or TIA, regardless of baseline LDL, unless there are contraindications. This is not an acute blood-pressure–lowering treatment, and the benefit does not depend on whether LDL is above target. Statins are generally safe in this setting and are not avoided due to bleeding risk, making them a cornerstone of post-stroke management.