Elevated low-density lipoprotein-cholesterol (LDL-C) is a causal factor for the development of atherosclerotic cardiovascular disease (ASCVD); accordingly, LDL-C lowering is associated with a decreased risk of progression of atherosclerotic plaques and development of complications. Currently, statins play a central role in any ASCVD management and prevention strategies, in relation to their lipid-lowering action and potentially to pleiotropic effects. After coronary artery disease, stroke is the most frequent cause of ASCVD mortality and the leading cause of acquired disability, a major public health problem. There is often a tendency to aggregate all types of stroke (atherothrombotic, cardioembolic, and haemorrhagic), which have, however, different causes and pathophysiology, what may lead to bias when interpreting the results of the studies. Survivors of a first atherothrombotic ischemic stroke are at high risk for coronary events, recurrent stroke, and vascular death. Although epidemiological studies show a weak relationship between cholesterol levels and cerebrovascular disease as a whole compared with other ASCVD types, statin intervention studies have demonstrated a decrease in the risk of stroke in patients with atherosclerosis of other territories and a decrease in all cardiovascular events in patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial demonstrated the benefit of high doses of atorvastatin in the secondary prevention of ischemic stroke. In this review, we discuss the evidence, use and recommendations of statins in the primary and secondary prevention of stroke, and their role in other scenarios such as the acute phase of ischemic stroke, cerebral hemorrhage, cardioembolic stroke, small vessel disease, and cognitive impairment.

低密度脂蛋白胆固醇 (LDL-C) 升高是动脉粥样硬化性心血管疾病 (ASCVD) 发展的一个原因；因此，LDL-C 的降低与动脉粥样硬化斑块进展和并发症发生风险的降低有关。目前，他汀类药物在任何 ASCVD 管理和预防策略中都发挥着核心作用，这与它们的降脂作用和潜在的多效作用有关。在冠状动脉疾病之后，中风是导致 ASCVD 死亡的最常见原因，也是导致获得性残疾（一个主要的公共卫生问题）的主要原因。通常倾向于将所有类型的中风（动脉粥样硬化血栓形成、心源性栓塞和出血性中风）汇总在一起，然而，这些中风具有不同的原因和病理生理学，这可能会导致在解释研究结果时出现偏差。第一次动脉粥样硬化血栓形成缺血性卒中的幸存者处于冠状动脉事件、复发性卒中和血管性死亡的高风险中。尽管流行病学研究表明，与其他 ASCVD 类型相比，胆固醇水平与整体脑血管疾病之间的关系较弱，但他汀类药物干预研究表明，其他地区的动脉粥样硬化患者的卒中风险降低，患者的所有心血管事件发生率降低谁中风了。通过积极降低胆固醇水平预防中风 (SPARCL) 试验证明了高剂量阿托伐他汀在缺血性中风二级预防中的益处。在这篇综述中，我们讨论了他汀类药物在卒中一级和二级预防中的证据、使用和建议，