Suboptimal LDL-C Goal Attainment After Ischemic Stroke and TIA: Prevalence, Determinants, and Clinical Implications

Area of Science:

• Cardiology
• Neurology
• Public Health

Background:

• Achieving low-density lipoprotein cholesterol (LDL-C) targets is crucial for secondary prevention in patients with atherosclerotic ischemic stroke or transient ischemic attack (TIA).
• Assessing LDL-C goal attainment and identifying associated factors post-stroke/TIA is vital for optimizing patient outcomes.
• Current lipid-lowering strategies require evaluation for effectiveness in this high-risk population.

Purpose of the Study:

• To determine the prevalence of LDL-C goal attainment within 12 months post-discharge in Thai patients treated with statins after ischemic stroke or TIA.
• To identify clinical and therapeutic factors associated with achieving LDL-C goals and reducing LDL-C levels.
• To inform clinical practice regarding optimal lipid-lowering strategies for secondary stroke prevention.

Main Methods:

• A cohort study of 487 Thai patients (85.8% with ischemic stroke) discharged on statin therapy was conducted.
• LDL-C levels were assessed within 12 months post-discharge to evaluate goal attainment across various targets (<55, <70, <100 mg/dL, and ≥50% reduction).
• Logistic regression and generalized linear models were used to identify predictors of LDL-C goal attainment and reduction.

Main Results:

• Overall LDL-C goal attainment was modest, with rates of 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction.
• High-intensity statin use was a significant predictor for achieving LDL-C goals at <70 mg/dL, <100 mg/dL, and ≥50% reduction.
• High-intensity statins and baseline LDL-C levels were significant determinants of LDL-C reduction.

Conclusions:

• LDL-C target attainment after ischemic stroke/TIA remains suboptimal, particularly for more stringent goals.
• High-intensity statins demonstrate efficacy in improving LDL-C goal attainment and achieving greater LDL-C reductions.
• Wider implementation of aggressive lipid-lowering strategies, including high-intensity statins, is recommended for high-risk patients post-stroke/TIA.