{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:02:00Z","timestamp":1771977720619,"version":"3.50.1"},"reference-count":91,"publisher":"Georg Thieme Verlag KG","issue":"03","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thromb Haemost"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:p>Stroke remains a leading cause of morbidity and mortality worldwide, with ischemic stroke dominating the landscape. Dyslipidemia, particularly elevated low-density lipoprotein cholesterol (LDL-C), is a critical modifiable risk factor in both primary and secondary prevention of stroke. While statins have established their role in stroke prevention, questions remain regarding optimal treatment strategies for specific patient groups, the role of non-statin therapies, and lipid level targets for maximal benefit. Emerging evidence underscores the potential of novel lipid-lowering agents, namely, PCSK9 injectable therapies targeting PCSK9, bempedoic acid, and icosapent ethyl, to complement statins in specific patient groups, including those with statin intolerance, those needing further LDL reduction, and those at high residual risk because of high triglycerides. Furthermore, the variability in stroke subtypes and patient comorbidities highlights the need for individualized, evidence-based approaches to lipid management. This narrative review provides a comprehensive overview of available lipid-lowering therapies for post-stroke patients, proposing practical algorithms for \u201cwho\u201d to treat, \u201chow\u201d to treat them, and \u201chow much\u201d LDL-C reduction is needed. We aim to bridge gaps between clinical evidence and practice, focusing on individualized approaches to improve outcomes in this high-risk population.<\/jats:p>","DOI":"10.1055\/a-2675-0551","type":"journal-article","created":{"date-parts":[[2025,8,4]],"date-time":"2025-08-04T23:25:52Z","timestamp":1754349952000},"page":"227-243","source":"Crossref","is-referenced-by-count":2,"title":["Strategic Lowering of LDL-Cholesterol Post Ischemic Stroke: Identifying Optimal Targets, Timing, and Therapeutic Approaches"],"prefix":"10.1055","volume":"126","author":[{"given":"Nikolaos Gavriil","family":"Kolios","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, University of Ioanina, Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fotios","family":"Barkas","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, University of Ioanina, Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0629-9248","authenticated-orcid":false,"given":"George","family":"Ntaios","sequence":"additional","affiliation":[{"name":"1st Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haralampos","family":"Milionis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, School of Medicine, University of Ioanina, Ioannina, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"issue":"11","key":"ref1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S1474-4422(03)00558-1","article-title":"Management of acute ischaemic stroke: new guidelines from the American Stroke Association and European Stroke Initiative","volume":"2","author":"C J Klijn","year":"2003","journal-title":"Lancet Neurol"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1161\/STROKEAHA.118.023167","article-title":"Cholesterol lowering and prevention of stroke","volume":"50","author":"D G Hackam","year":"2019","journal-title":"Stroke"},{"issue":"08","key":"ref3","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1161\/CIRCOUTCOMES.122.009787","article-title":"Gaps in guideline-based lipid-lowering therapy for secondary prevention in the United States: a retrospective cohort study of 322 153 patients","volume":"16","author":"A M Navar","year":"2023","journal-title":"Circ Cardiovasc Qual Outcomes"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"776","DOI":"10.3390\/medicina59040776","article-title":"Medical management of dyslipidemia for secondary stroke prevention: narrative review","volume":"59","author":"Y Chang","year":"2023","journal-title":"Medicina (Kaunas)"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"I","DOI":"10.1177\/23969873221100032","article-title":"European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack","volume":"7","author":"J Dawson","year":"2022","journal-title":"Eur Stroke J"},{"issue":"24","key":"ref6","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1093\/eurheartj\/ehz962","article-title":"Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel","volume":"41","author":"J Bor\u00e9n","year":"2020","journal-title":"Eur Heart J"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.athplu.2024.01.004","article-title":"Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 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