Key result
Sustained LDL-C attainment links to ~60% fewer recurrent ischemic cerebrovascular events, particularly in large-artery disease.
Why the study?
Evidence remains limited on sustained LDL-C target attainment as a time-varying exposure and recurrent ischemic cerebrovascular events in real-world ischemic stroke, particularly with significant large-artery atherosclerotic stenosis.
Does sustained LDL-C target attainment (<1.8 mmol/L) reduce recurrent ischemic cerebrovascular events in patients with ischemic stroke and baseline LDL-C ≥1.8 mmol/L?
Cohort (n=933)
No
Does sustained LDL-C target attainment (<1.8 mmol/L) reduce recurrent ischemic cerebrovascular events in patients with ischemic stroke and baseline LDL-C ≥1.8 mmol/L?
Hazard Ratio: 0.399 (95% CI 0.269–0.593)
p-value: p=<0.001
Sustained attainment of LDL-C < 1.8 mmol/L significantly reduces the risk of recurrent ischemic cerebrovascular events in stroke patients, particularly those with large-artery disease.
May support sustained LDL-C targets post-stroke; extends observational data in large-artery disease but leaves open RCT confirmation.
Background In secondary prevention after ischemic stroke or TIA, LDL-C < 1.8 mmol/L is associated with a lower risk of recurrent vascular events. However, evidence remains limited in real-world patients with ischemic stroke, especially those with significant large-artery atherosclerotic stenosis. In particular, few studies have evaluated the impact of sustained LDL-C target attainment on recurrent ischemic cerebrovascular events by using LDL-C target attainment as a time-varying exposure. Methods We retrospectively studied 933 patients with ischemic stroke who had baseline LDL-C levels ≥1.8 mmol/L at admission. Significant large-artery disease (LAD) was defined as ≥50% intracranial or extracranial atherosclerotic stenosis. LDL-C target attainment was defined as <1.8 mmol/L. The primary outcome was recurrent ischemic cerebrovascular events. Time-dependent Cox models evaluated the association between time-varying LDL-C target attainment and recurrence, and effect modification by LAD status was assessed. The proportion of follow-up time with LDL-C ≥ 1.8 mmol/L was additionally assessed. Results Among 933 patients, 369 had LAD and 564 did not. During follow-up, 102 recurrent ischemic cerebrovascular events occurred. In the fully adjusted model, time-varying LDL-C target attainment was associated with lower recurrence risk [hazard ratio (HR) = 0.399, 95% confidence interval (CI): 0.269–0.593, p < 0.001]. This association was stronger in patients with LAD (HR = 0.282, 95% CI: 0.168–0.475, p < 0.001) than in those without LAD (HR = 0.530, 95% CI: 0.288–0.976; p = 0.042; P for interaction = 0.041). Each 10% increase in the proportion of follow-up time with LDL-C ≥ 1.8 mmol/L was associated with higher recurrence risk (HR = 1.189, 95% CI 1.127–1.254), with a stronger association in LAD patients (P for interaction = 0.008). Conclusion Among patients with ischemic stroke who had baseline LDL-C levels ≥1.8 mmol/L at admission, sustained LDL-C target attainment was associated with a lower risk of recurrence after ischemic stroke. This association was particularly evident in patients with significant LAD. Sustained LDL-C control may support risk stratification and secondary prevention.
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Zhang et al. (2026) conducted a cohort in Ischemic stroke (n=933). Time-varying LDL-C target attainment (<1.8 mmol/L) vs. LDL-C ≥1.8 mmol/L was evaluated on Recurrent ischemic cerebrovascular events (HR 0.399, 95% CI 0.269-0.593, p=<0.001). Sustained LDL-C target attainment (<1.8 mmol/L) was associated with a 60% lower risk of recurrent ischemic cerebrovascular events (HR 0.399), particularly in patients with large-artery disease.
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