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A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke
Pierre Amarenco1, Jong S Kim1, Julien Labreuche1
1From the Department of Neurology and Stroke Center (P.A., J.L., H.C., L.C., C.G., C.H., P.C.L., E.M., P.-J.T.) and the Department of Cardiology (J.A., G.D., P.G.S.), Assistance Publique-Hôpitaux de Paris (APHP), Bichat Hospital, Laboratory for Vascular Translational Science, INSERM Unité 1148, Département Hospitalo Universitaire-Fibrose Inflammation Remodelage, and the Department of Cardiology, Cochin Hospital (O.V.), University of Paris, the Department of Neurology, Foch Hospital (B.L.), Urgences Cerebrovasculaires (Y.S.), Centre de Pharmacoépidémiologie de l'APHP (N.Y.), and the Department of Endocrinology (E.B.), Hôpital de la Pitié-Salpêtrière, the Department of Biostatistics, APHP, Université Paris Diderot, Sorbonne Paris Cité, Fernand Widal Hospital (É.V.), and the Department of Endocrinology, Sorbonne University (E.B.), Paris, Équipe d'Accueil EA2694, Santé Publique: Epidémiologie et Qualité des Soins (J.L.), and the Department of Neurology, Stroke Unit, University of Lille, Centre Hospitalier Universitaire (CHU) de Lille (D.L.), Lille, the Department of Neurology, University Hospital of Dijon, University of Burgundy, Dijon (Y.B., M.G.), the Stroke Unit, Pasteur Hospital, Nice (M.-H.M.), Hospices Civils de Lyon, Department of Neurology and Stroke Center, Lyon University, Lyon (N.N.), the Department of Neurology, Versailles University Hospital, Versailles (F.P.), the Department of Vascular Neurology, Pellegrin Tripode Hospital, University of Bordeaux, Bordeaux (I.S.), and the Department of Neurology, Université Caen Normandie, CHU Caen Normandie, INSERM Unité 1237, Cyceron, Caen (E.T.) - all in France; Asan Medical Center (J.S.K.), the Department of Neurology, Eunpyeong St. Mary's Hospital, Catholic University of Korea (Y.-J.K.), and the Department of Neurology, Soonchunhyang University College of Medicine (K.-B.L.), Seoul, Dong-a University Hospital (J.-K.C.) and the Department of Neurology and Stroke Center, Pusan National University Hospital (S.M.S.), Busan, and the Department of Neurology, Hallym University Sacred Heart Hospital, Anyang (B.-C.L.) - all in South Korea; and the National Heart and Lung Institute-Imperial College and the Institute of Cardiovascular Medicine and Science-Royal Brompton Hospital, London (P.G.S.).
Lowering low-density lipoprotein (LDL) cholesterol to below 70 mg/dL after stroke or TIA significantly reduces cardiovascular events. This intensive lipid-lowering therapy is crucial for patients with atherosclerotic conditions, improving outcomes and preventing future events.
Area of Science:
- Cardiology
- Neurology
- Clinical Trials
Background:
- Intensive lipid-lowering therapy with statins is recommended post-atherosclerotic transient ischemic attack (TIA) and ischemic stroke.
- Optimal low-density lipoprotein (LDL) cholesterol targets to minimize cardiovascular events after stroke remain under investigation.
Purpose of the Study:
- To compare the efficacy of two LDL cholesterol target levels in reducing major cardiovascular events in patients with recent ischemic stroke or TIA.
Main Methods:
- A parallel-group trial randomized 2860 patients with recent ischemic stroke or TIA to either a lower LDL target (<70 mg/dL) or a higher target (90-110 mg/dL).
- Patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received statin, ezetimibe, or both.
- The primary endpoint was a composite of major cardiovascular events, including ischemic stroke, myocardial infarction, urgent revascularization, or cardiovascular death.
Main Results:
- The trial followed 2860 patients for a median of 3.5 years, achieving mean LDL levels of 65 mg/dL (lower-target) and 96 mg/dL (higher-target).
- The composite primary endpoint occurred in 8.5% of the lower-target group versus 10.9% in the higher-target group (adjusted hazard ratio, 0.78; P=0.04).
- No significant differences were observed in the incidence of intracranial hemorrhage or newly diagnosed diabetes between the groups.
Conclusions:
- Targeting an LDL cholesterol level below 70 mg/dL after ischemic stroke or TIA in patients with atherosclerosis led to a significantly lower risk of subsequent cardiovascular events compared to a target range of 90-110 mg/dL.
- The findings support more aggressive LDL cholesterol reduction in this patient population to enhance secondary prevention of cardiovascular events.
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