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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Guideline-directed low-density lipoprotein management in high-risk ischemic stroke or transient ischemic attack
Hong-Qiu Gu1,2, Kai-Xuan Yang1,2, Xin Yang1,2
1China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Achieving target low-density lipoprotein cholesterol (LDL-C) levels for secondary stroke prevention is low, even in high-risk patients with cardiovascular disease (CVD) or cerebrovascular disease (CeVD). This highlights a critical need for improved dyslipidemia management in stroke survivors.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Public Health
Background:
- Lowering low-density lipoprotein cholesterol (LDL-C) is vital for preventing recurrent strokes in patients with existing cardiovascular diseases (CVD) or cerebrovascular diseases (CeVD).
- Current data on the achievement of guideline-recommended LDL-C levels in these high-risk populations are insufficient.
Purpose of the Study:
- To evaluate the attainment rates of guideline-recommended LDL-C targets in patients hospitalized for ischemic stroke or transient ischemic attack (TIA).
- To identify factors associated with achieving LDL-C goals in this patient cohort.
Main Methods:
- Analysis of data from the Chinese Stroke Center Alliance (CSCA) program, including patients hospitalized between August 2015 and July 2019.
- Patients were categorized based on pre-existing cerebrovascular disease (CeVD) and/or cardiovascular disease (CVD).
- Assessment of LDL-C levels against target goals (<2.6 mmol/L, <1.8 mmol/L, <1.4 mmol/L).
Main Results:
- Out of 858,509 patients, only 46.3% achieved LDL-C <2.6 mmol/L, with lower rates for stricter targets.
- Patients with concomitant CeVD and CVD showed higher attainment rates (P<0.001).
- Despite improvements over time, LDL-C target attainment remained suboptimal. Factors like younger age, female sex, hypertension, dyslipidemia history, smoking/drinking, and eastern China location were linked to lower achievement odds.
Conclusions:
- Overall achievement of guideline LDL-C targets in stroke/TIA patients is low.
- There is a significant need for enhanced dyslipidemia management strategies, especially for high-risk stroke patients with pre-existing CeVD or CVD.
Background:
Lowering low-density lipoprotein cholesterol (LDL-C) is crucial for secondary stroke prevention in stroke patients with preexisting cardiovascular diseases (CVD) or cerebrovascular diseases (CeVD). However, data on attainment of guideline-recommended LDL-C levels are lacking.
Methods:
We analyzed data from the Chinese Stroke Center Alliance (CSCA) program for patients with ischemic stroke and transient ischemic attack (TIA) hospitalized between August 2015 and July 2019. Participants were classified into different disease groups according to preexisting CeVD (stroke/TIA) or CVD [coronary heart disease (CHD) or myocardial infarction (MI)].
Results:
Of 858,509 patients presenting with an acute stroke/TIA, 251,176 (29.3%) had a preexisting CeVD, 44,158 (5.1%) had preexisting CVD, 33,070 (3.9%) had concomitant preexisting CeVD and CVD, and 530,105 (61.7%) had no documented history of CeVD/CVD. Overall, only 397,596 (46.3%) met the target for LDL-C <2.6 mmol/L, 128,177 (14.9%) for LDL-C <1.8 mmol/L and 55,275 (6.4%) for LDL-C <1.4 mmol/L, and patients with concomitant CeVD and CVD had higher attainment rates than other disease groups (P<0.001). Despite improvements over time in the proportion of patients who attain LDL-C targets (P for trend <0.05), it remains suboptimal. Younger age, women, having a history of hypertension or dyslipidemia, current smoking or drinking, and being admitted to hospitals located in eastern China were associated with lower odds of meeting the LDL-C goals.
Conclusions:
Overall attainment of guideline LDL-C targets in a population of stroke/TIA patients is low and indicates the need for better management of dyslipidemia, particularly for high-risk stroke patients with pre-existing CeVD or CVD.
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