Long-term LDL cholesterol burden and stroke: mechanistic insights and emerging strategies for personalized lipid...

Area of Science:

• Cardiology
• Neurology
• Preventive Medicine

Background:

• Low-density lipoprotein cholesterol (LDL-C) is a key driver of atherosclerotic cardiovascular disease and ischemic stroke.
• Cumulative LDL-C exposure, considering both level and duration, more accurately reflects vascular injury than single measurements.
• Understanding long-term LDL-C burden is crucial for effective stroke prevention strategies.

Purpose of the Study:

• To review the quantification of long-term LDL-C burden.
• To summarize epidemiological evidence linking cumulative LDL-C exposure to ischemic stroke.
• To discuss the role of lipid-lowering therapies in reducing vascular injury and the challenges in managing hemorrhagic risk.

Main Methods:

• Literature review of studies on cumulative LDL-C exposure and stroke.
• Analysis of epidemiological data on LDL-C burden and ischemic stroke incidence/recurrence.
• Examination of biological mechanisms and therapeutic interventions for lipid management.

Main Results:

• Cumulative LDL-C exposure is a stronger predictor of vascular injury and stroke than static LDL-C levels.
• Lipid-lowering therapies can mitigate cumulative vascular damage, but careful risk-benefit assessment is needed.
• A precision-management framework integrating longitudinal data improves cerebrovascular prevention.

Conclusions:

• Shifting focus to lifelong cumulative LDL-C exposure provides a more accurate basis for individualized stroke prevention.
• Precision management integrating lipid exposure, stroke characteristics, and other factors optimizes cerebrovascular care.
• Further research into balancing ischemic and hemorrhagic risks in specific patient groups is warranted.