The Management of <scp>LDL</scp> Cholesterol and Predictors of Goal Achievement in Stroke Patients in China: A Cross‐Sectional Study

Wang, Chunjuan; Wang, Yilong; Li, Zixiao

doi:10.1111/cns.12543

Cited by 9 publications

(11 citation statements)

References 27 publications

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“…Third, we described the epidemiological characteristics of Chinese patients with IS/TIA in relation to their LDL-C levels and LLT. Compared with the study conducted in 2013, 21 our study indicated some progress in blood lipid management in mainland China. Notably, about 97% of patients had LLT medication history prior to the entry into our study.…”

Section: Discussioncontrasting

confidence: 55%

Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

Chen

Wang

et al. 2023

BMJ Open

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ObjectivesThe aims of the study were to assess the management of low-density lipoprotein cholesterol (LDL-C) and the goal achievement, as well as to investigate the association between baseline LDL-C level, lipid-lowering treatment (LLT), and stroke recurrence in patients with ischaemic stroke or transient ischaemic attack (TIA).DesignOur study was a post hoc analysis of the Third China National Stroke Registry (CNSR-III).SettingWe derived data from the CNSR-III - a nationwide clinical registry of ischaemic stroke and TIA based on 201 participating hospitals in mainland China.Participants15,166 patients were included in this study with demographic characteristics, etiology, imaging, and biological markers from August 2015 to March 2018.Primary and secondary outcome measuresThe primary outcome was a new stroke, LDL-C goal (LDL-C<1.8mmol/L and LDL-C<1.4mmol/L, respectively) achievement rates, and LLT compliance within 3, 6, and 12 months. The secondary outcomes included major adverse cardiovascular events (MACE) and all caused death at 3 and 12 months.ResultsAmong the 15,166 patients, over 90% of patients received LLT during hospitalization and 2 weeks after discharge; the LLT compliance was 84.5% at 3 months, 75.6% at 6 months, and 64.8% at 12 months. At 12 months, LDL-C goal achievement rate for 1.8mmol/L and 1.4mmol/L was 35.4% and 17.6%, respectively. LLT at discharge was associated with reduced risk of ischemic stroke recurrence (HR=0.69, 95% CI: 0.48-0.99, p=0.04) at 3 months. The rate of LDL-C reduction from baseline to 3-month follow-up was not associated with a reduced risk of stroke recurrence or major adverse cardiovascular events (MACE) at 12 months. Patients with baseline LDL-C ≤1.4mmol/L had a numerically lower risk of stroke, ischemic stroke and MACE at both 3 months and 12 months.ConclusionsThe LDL-C goal achievement rate has increased mildly in the stroke and TIA population in mainland China. Lowered baseline LDL-C level was significantly associated with a decreased short- and long-term risk of ischemic stroke among stroke and TIA patients. LDL-C<1.4mmol/L might be a safe standard for this population.

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Section: Discussioncontrasting

confidence: 55%

Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

Chen

Wang

et al. 2023

BMJ Open

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“…7 Lipid-lowering therapy (LLT) has been identified as a positive predictor of LDL-C goal attainment. 8,9 Statin-based LLT reduces the risk of subsequent cardiovascular (CV) events such as cause-specific mortality, and major vascular events in patients with stable coronary heart disease (CHD) or ACS. 10 Intensive LLT in ACS survivors has demonstrated improved long-term clinical outcomes in PROVE-IT 11 and IMPROVE-IT 12 studies.…”

Section: Introductionmentioning

confidence: 99%

Lipid goal attainment in post‐acute coronary syndrome patients in China: Results from the 6‐month real‐world dyslipidemia international study II

Gong

Li²,

et al. 2021

Clinical Cardiology

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Background: Dyslipidemia International Study II (DYSIS II)-China was conducted to determine the low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) attainment rate in patients with post-acute coronary syndrome (ACS). Hypothesis: Compliance with treatment guideline recommendations improves the LDL-C goal attainment rate in post-ACS patients.Methods: This multicenter prospective observational study conducted at 28 tertiary hospitals determined the LDL-C goal attainment rates at admission and 6-month follow-up in patients on lipid-lowering treatment (LLT) for ≥3 months and those not on LLT (LLT-naive or off LLT for ≥3 months) at admission. Predictors of goal attainment at 6 months were identified using multivariate logistic regression. Results:The LDL-C goal attainment rate at admission in 1102/1103 enrolled patients was 17.1%; it was 41.2% among 752 patients with available lipid results at 6 months.The distance to goal was 0.7 mmol/L at 6 months. Statin monotherapy was the most prescribed LLT. Only 7.7% of patients were receiving statin + ezetimibe and 8.4% of patients were receiving an atorvastatin-equivalent dose of ≥40 mg/day at 6 months.Being male (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6) and undergoing percutaneous coronary intervention during index hospitalization (OR 1.5, 95% CI 1.1 to 2.1) were the independent predictors for LDL-C goal attainment.Conclusions: This real-world DYSIS II study in China reports a low LDL-C goal attainment rate in post-ACS patients even after 6 months of LLT. Lack of intensification of statin therapy and underutilization of combinations suggest gaps between real-world treatment practices and guideline recommendations.

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“…In accordance with the selection criteria, we ultimately included five studies (Figure 1) (18)(19)(20)(21)(22). A total of 1,821 cases and 3,178 controls were included in the five cohort studies.…”

Section: Resultsmentioning

confidence: 99%

Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China

Chen

Zhong

Ran³

et al. 2020

Front. Neurol.

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Background: The benefit of blood cholesterol reduction for secondary prevention of ischemic stroke remains undetermined in Chinese patients. The purpose of this meta-analysis was to determine whether lipid-lowering agents including statins, fibrates, nicotinic acid, and ezetimibe reduced the risk of recurrent stroke in ischemic stroke patients in China and whether such findings could inform treatment decisions for blood lipid-lowering treatment in China.Methods: The English electronic databases PubMed, EMBASE, Cochrane Library and Chinese databases CNKI, Sino-Med, Wan Fang, and VIP were searched for studies published between January 1990 and April 2020. This meta-analysis included published data from trials that randomly assigned patients to groups treated with either blood lipid-lowering regimens or placebo. Effect comparisons were made using fixed effects model in meta-analysis and linear and spline regression were performed to identify the relative risk of stroke recurrence. The primary outcome was the reduction of total ischemic stroke events, and relative risk values were obtained using a risk prediction equation developed from the control groups of the included trials.Results: Five studies including 4,999 individuals with available data met the inclusion criteria. Relative to the control groups, the pooled estimated odds ratio (OR) for recurrent stroke among those who received lipid-lowering therapy was 0.79 (95% confidence interval [CI]: 0.63–1.00). A 50% or greater reduction in low-density lipoprotein cholesterol (LDL-C) significantly reduced the risk of ischemic stroke recurrence (OR: 0.15 [95% CI: 0.11–0.20]). The overall beneficial effect of statin therapy was confirmed to prevent ischemic stroke with an OR of 0.51 (95% CI: 0.36–0.72).Conclusions: Effective lipid-lowering therapy could decrease the blood LDL-C level, which had a protective effect against stroke recurrence. These results support the use of predicted baseline cerebrovascular disease risk equations to inform decisions regarding blood lipid-lowering treatment in ischemic stroke patients in China.

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The Management of LDL Cholesterol and Predictors of Goal Achievement in Stroke Patients in China: A Cross‐Sectional Study

Cited by 9 publications

References 27 publications

Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

Lipid goal attainment in post‐acute coronary syndrome patients in China: Results from the 6‐month real‐world dyslipidemia international study II

Meta-Analysis of Dyslipidemia Management for the Prevention of Ischemic Stroke Recurrence in China

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