In patients with atherosclerotic disease who have experienced an episode of ischaemic stroke or transient ischaemic attack, a target LDL-cholesterol (LDL-C) level of <70 mg/dl, compared with a target of 90–110 mg/dl, is associated with a reduced risk of subsequent cardiovascular events. These findings come from a parallel-group trial that involved 2,860 patients who were randomly assigned to one of the LDL-C target groups and followed up for a median of 3.5 years. At follow-up, the mean LDL-C levels of the lower-target and higher-target groups were 65 mg/dl and 96 mg/dl, respectively. The composite primary end point of major cardiovascular events occurred in 8.5% of the lower-target group and 10.9% of the higher-target group (adjusted HR 0.78, 95% CI 0.61–0.98, P = 0.04). “The results of our trial suggest that a target LDL-C level of <70 mg/dl could provide a further risk reduction,” conclude the investigators.
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Amarenco, P. et al. A comparison of two LDL cholesterol targets after ischemic stroke. N. Engl. J. Med. https://doi.org/10.1056/NEJMoa1910355 (2019)
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Huynh, K. A lower LDL-C target is better after stroke. Nat Rev Cardiol 17, 70 (2020). https://doi.org/10.1038/s41569-019-0319-6
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DOI: https://doi.org/10.1038/s41569-019-0319-6