NeuroRehabilitation · Nov 6, 2026

Neurorehabilitation as an Opportunity for Structured Post-Stroke Lipid Management: A Narrative Review

By Fezeu F, Kalle F, Odukudu GD et al.

Background and Purpose: Ischemic stroke remains a major cause of death, disability, and recurrent vascular events worldwide. Although lipid-lowering therapy is central to secondary prevention, the transition between acute stroke care and long-term outpatient management remains a vulnerable period during which guideline-directed treatment is frequently delayed, undertitrated, or discontinued. Neurorehabilitation may provide an important opportunity to address this gap. This narrative review summarizes evidence supporting intensive low-density lipoprotein cholesterol (LDL-C) reduction after ischemic stroke and examines how the neurorehabilitation setting may facilitate optimized lipid management. Methods: A literature search was performed in PubMed/MEDLINE, Embase, and the Cochrane Library through March 2026, combining terms across three domains: (1) ischemic stroke and secondary prevention, (2) lipid-lowering therapy, and (3) neurorehabilitation and functional recovery. Included study types encompassed randomized controlled trials, systematic reviews with meta-analyses, clinical practice guidelines, observational cohort and preclinical studies addressing statin pleiotropic effects. Priority was given to landmark randomized trials, major society guidelines, and studies with direct relevance to recurrent stroke prevention, hemorrhagic risk stratification, and rehabilitation-based care delivery. Results: Evidence from SPARCL, Treat Stroke to Target, FOURIER, and Ez PAVE shows that intensive LDL-C reduction improves secondary stroke prevention. Statins may also affect neuroinflammation, endothelial function, blood–brain barrier integrity, and neuroplasticity, with differences in hemorrhagic stroke risk and safety profiles compared with PCSK9 inhibitors. Conclusion: Although direct rehabilitation-based randomized trials are lacking, integrating supervised medication titration, adherence monitoring, neuroimaging-guided risk stratification, and patient-centered secondary prevention strategies into neurorehabilitation may represent a practical approach for strengthening secondary stroke prevention and reducing recurrent vascular events.

doi.org/10.1177/10538135261501053PubMed 42992449Interventions