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.