Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis

Abstract

Background Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings can be generalized to Asian patients, or that similar LDL‐C targets should be adopted in patients with stroke without significant atherosclerosis. Methods and Results We performed a prospective cohort study and recruited consecutive Chinese patients with ischemic stroke with magnetic resonance angiography of the intra‐ and cervicocranial arteries performed at the University of Hong Kong between 2008 and 2014. Serial postevent LDL‐C measurements were obtained. Risk of major adverse cardiovascular events in patients with mean postevent LDL‐C <1.80 versus ≥1.80 mmol/L, stratified by presence or absence of significant (≥50%) large‐artery disease (LAD) and by ischemic stroke subtypes, were compared. Nine hundred four patients (mean age, 69±12 years; 60% men) were followed up for a mean 6.5±2.4 years (mean, 9±5 LDL‐C readings per patient). Regardless of LAD status, patients with a mean postevent LDL‐C <1.80 mmol/L were associated with a lower risk of major adverse cardiovascular events (with significant LAD: multivariable‐adjusted subdistribution hazard ratio, 0.65; 95% CI, 0.42–0.99; without significant LAD: subdistribution hazard ratio, 0.53; 95% CI, 0.32–0.88) (both P <0.05). Similar findings were noted in patients with ischemic stroke attributable to large‐artery atherosclerosis (subdistribution hazard ratio, 0.48; 95% CI, 0.28–0.84) and in patients with other ischemic stroke subtypes (subdistribution hazard ratio, 0.64; 95% CI, 0.43–0.95) (both P <0.05). Conclusions A mean LDL‐C <1.80 mmol/L was associated with a lower risk of major adverse cardiovascular events in Chinese patients with ischemic stroke with and without significant LAD. Further randomized trials to determine the optimal LDL‐C cutoff in stroke patients without significant atherosclerosis are warranted.

Association Between Intensity of Low-Density Lipoprotein Cholesterol Reduction With Statin-Based Therapies and Secondary Stroke Prevention

“…An elevated low-density lipoprotein cholesterol (LDL-C) level is a risk factor for cardiovascular disease, including ischemic stroke . For patients with a history of ischemic stroke, an elevated LDL-C level is associated with an increased risk of subsequent major cardiovascular events . More intensive compared with less intensive LDL-C–lowering statin-based therapies are associated with reduced major cardiovascular events in patients with established atherosclerotic cardiovascular disease .…”

“…1 For patients with a history of ischemic stroke, an elevated LDL-C level is associated with an increased risk of subsequent major cardiovascular events. 2 More intensive compared with less intensive LDL-Clowering statin-based therapies are associated with reduced major cardiovascular events in patients with established atherosclerotic cardiovascular disease. 3 However, the results of LDL lowering with statins in secondary stroke prevention trials are inconsistent.…”

Using integrated GC-MS analysis, in vitro experiments, network pharmacology: exploring migao fatty oil active components/mechanisms against coronary heart disease

“…Atherosclerosis is a chronic inflammatory condition in which lipid-rich plaques in the walls of arteries result in constriction. Elevated levels of low-density lipoprotein cholesterol (LDL) constitute major risk factors for atherosclerosis (Lau et al, 2021). LDL is oxidatively modified and accumulates in blood vessel walls.…”

Role of microglia in stroke

“…Underlying factors include stroke recurrence and chronic vascular pathology like cSVD or CAA. The accumulation of clinically silent small strokes is very prevalent in patients over age 70 and is boosted by atherosclerosis and cardiovascular risk factors such as hypertension and hyperlipidemia (Cortes‐Canteli & Iadecola, 2020; Lau et al, 2021). Human neuropathological studies often show mixed dementias where vascular lesions and neurodegenerative pathology co‐exist (Kalaria et al, 2024).…”