#VisualAbstract: A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke

1. This randomized controlled trial showed that patients with ischemic stroke or transient ischemic attack with target LDL levels of less than 70 mg/dL had lower rates of subsequent cardiovascular events when compared to target LDL levels of 90 to 110 mg/dL. 

2. Patients were provided with a statin and ezetimibe for cholesterol control, as well as counseling on blood pressure, diabetic control, and smoking cessation.

Evidence Rating Level: 1 (Excellent)      

Study Rundown: High cholesterol levels are a known risk factor for having a transient ischemic attack (TIA) and ischemic stroke. After having a TIA or stroke, intense statin therapy is recommended to decrease cholesterol levels by the American Heart Association and American Stroke Association, but they do not specify a target low-density lipoprotein (LDL) level. This randomized controlled trial evaluated the effects of target LDL cholesterol levels on recurrent major cardiovascular events in patients with a recent ischemic stroke or TIA. One group was assigned a target LDL of less than 70 mg/dL and the other group was assigned a target of 90 to 110 mg/dL. Participants were followed for an average of 3.5 years and provided with counseling on blood pressure control, diabetes control, and smoking cessation. The lower-target LDL group had lower rates of subsequent cardiovascular events occur when compared to the higher-target LDL group. This effect was driven mainly by a decrease in rate of subsequent cerebral infarction. Due to the trial ending early and inclusion of only two countries, further research is needed to determine longer-term risks and benefits of LDL targets as well as alternative LDL targets.

Click to read the study in NEJM