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Association of Non-LDL Indices with Recurrent Stroke Risk while on Lipid-Modifying Therapy
Jong-Ho Park1, Bruce Ovbiagele2
1Department of Neurology, Myongji Hospital, Hanyang University College of Medicine.
Insights
Lipid-modifying therapy (LT) use after stroke may reduce recurrent stroke risk. Achieving optimal lipid levels, including higher high-density lipoprotein cholesterol (HDL-C), appears to further decrease vascular events and mortality.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Low-density lipoprotein (LDL)-lowering therapy is standard for secondary stroke prevention.
- The impact of non-LDL lipid levels on recurrent stroke risk during lipid-modifying therapy (LT) is not well understood.
Purpose of the Study:
- To investigate the association between different lipid profiles during LT and recurrent stroke risk.
- To determine if specific non-LDL targets influence vascular event rates in stroke survivors on LT.
Main Methods:
- Analysis of a multicenter trial with 3640 recent noncardioembolic stroke patients followed for 2 years.
- Patients were categorized into four groups based on LT use and lipid levels (LDL, HDL-C, triglycerides).
- Independent associations of LT category with stroke, major vascular events (MVEs), and all-cause death were assessed using multivariable analyses.
Main Results:
- Recurrent stroke rates decreased progressively with increasing LT category levels.
- Adjusted hazard ratios for stroke were significantly lower in the highest LT category (level III) compared to no LT use (level 0).
- Similar risk reduction patterns were observed for MVEs and all-cause death across LT categories.
Conclusions:
- A hierarchy of residual vascular risk exists based on non-LDL lipid profiles while on LT.
- Stroke patients with low high-density lipoprotein cholesterol (HDL-C) on LT may require additional strategies to optimize outcomes.
- Optimizing lipid profiles beyond LDL lowering may enhance secondary stroke prevention.
Aims:
Low-density lipoprotein (LDL)-lowering statin therapy is an established secondary stroke prevention strategy. However, the differential impact of key non-LDL levels on recurrent stroke risk, while on lipid-modifying therapy (LT), remains unclear.
Methods:
We analyzed the dataset of a multicenter trial involving 3640 recent (＜4 months) noncardioembolic stroke patients followed for 2 years. Participants were categorized into four groups of presumed improving lipid profile: level 0, no LT prescribed; level I, LT use with low high-density lipoprotein cholesterol (HDL-C) (＜40 mg/dL for men; ＜50 mg/dL for women); level II, LT use with high HDL-C (≥ 40 mg/dL and ≥ 50 mg/dL, respectively); and level III, level II with low triglycerides (＜150 mg/dL). Independent associations of LT category with stroke, major vascular events (MVEs; stroke/coronary heart disease/vascular death), and all-cause death were assessed.
Results:
LTs were mostly statins (＞95%). The unadjusted recurrent stroke rate declined with LT category level (9.2% for level 0; 8.4% for level I; 7.5% for level II; and 5.7% for level III). Compared with level 0, the adjusted hazard ratio of stroke for level I was 0.78 (95% confidence interval (CI), 0.59-1.03), level II 0.80 (0.54-1.18), and level III 0.63 (0.43-0.91). Multivariable analyses of MVEs and all-cause death followed a similar pattern of declining risk with higher LT category level.
Conclusions:
Compared with the nonuse of LT, there may be a hierarchy of residual vascular risk after stroke by non-LDL type and target, while on LT. Particularly, stroke patients with low HDL-C levels on LT may benefit from additional therapeutic strategies to improve their outcomes.
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