Background: Patients with previous strokes are at a higher risk of stroke recurrence. Current guidelines recommend a range of low-density lipoprotein cholesterol (LDL-C)-lowering treatments to reduce the risk of recurrent stroke. However, the optimal agent for decreasing LDL-C to lower the risk of recurrent stroke remains unclear. This study aimed to assess the relative effects of various LDL-C -lowering agents for secondary stroke prevention. Methods: Several databases were searched from inception up to 2022. Only randomized controlled trials that compared different LDL-C-lowering agents in adult patients with previous strokes were included. The primary endpoint was a recurrent stroke. The surface under the cumulative ranking curve (SUCRA) was also applied to estimate the overall ranking probability of the treatment agents for each outcome. Results: Overall, nine trials comprising 17,226 patients were included. Ezetimibe plus statins (RR: 0.56, 95% CrI: 0.35-0.87) and statins alone (RR: 0.90, 95% CrI: 0.81-1.00) reduced the risk of stroke recurrence. Ezetimibe plus statins was superior to statins alone in decreasing the incidence of recurrent stroke (RR: 0.62, 95% CrI: 0.39-0.95). However, treatment with statins was related to an increased risk of hemorrhagic stroke compared to placebo (RR: 1.57, 95% CrI: 1.13-2.21). All agents were related to a decreased incidence of major adverse cardiovascular events. Conclusion: Treatment with ezetimibe plus statins was suggested as the most efficacious in decreasing the incidence of recurrent stroke. The analysis also revealed that statin monotherapy was related to an increased risk of hemorrhagic stroke.

中文翻译：

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中风患者二级预防的低密度脂蛋白胆固醇降低疗法：网络荟萃分析

背景：既往有中风史的患者中风复发的风险较高。目前的指南推荐一系列降低低密度脂蛋白胆固醇（LDL-C）的治疗方法，以降低中风复发的风险。然而，降低 LDL-C 以降低卒中复发风险的最佳药物仍不清楚。本研究旨在评估各种降低 LDL-C 药物对中风二级预防的相对效果。方法：检索了从成立到 2022 年的多个数据库。仅纳入了比较不同 LDL-C 降低药物对既往中风的成年患者的随机对照试验。主要终点是复发性卒中。累积排名曲线下的曲面 (SUCRA) 也用于估计每种结果的治疗药物的总体排名概率。结果：总体而言，纳入了 9 项试验，涉及 17,226 名患者。依折麦布联合他汀类药物（RR：0.56，95% CrI：0.35-0.87）和单独使用他汀类药物（RR：0.90，95% CrI：0.81-1.00）可降低卒中复发风险。依折麦布联合他汀类药物在降低卒中复发率方面优于单独使用他汀类药物（RR：0.62，95% CrI：0.39-0.95）。然而，与安慰剂相比，他汀类药物治疗会增加出血性中风的风险（RR：1.57，95% CrI：1.13-2.21）。所有药物均与主要不良心血管事件发生率降低有关。结论：依折麦布联合他汀类药物治疗被认为是降低卒中复发率最有效的方法。分析还显示，他汀类药物单一疗法与出血性中风风险增加有关。