The optimal cholesterol level after stroke or TIA | The Daily Star
12:00 AM, December 08, 2019 / LAST MODIFIED: 12:00 AM, December 08, 2019

CHOLESTEROL

The optimal cholesterol level after stroke or TIA

Use of statins after ischaemic stroke or transient ischaemic attack (TIA) has been recommended in guidelines for more than a decade. However, some epidemiologic studies (Stroke 2013; 44:1833) have raised the issue of whether excessive LDL cholesterol-lowering increases the risk for brain haemorrhage.

The investigators enrolled 2,860 patients (mean age, 67; 68% male), 86% with a recent ischaemic stroke (within three months) and 14% with a TIA (within 15 days). Participants were randomised to a lower target of LDL ((70 mg/dL) or a higher target of LDL (90–110 mg/dL).

Stroke patients were enrolled an average of 6 days after the event. All patients had to have a cerebral atherosclerotic disease, aortic plaques, or coronary artery disease. Local physicians could prescribe any statin with or without ezetimibe. The composite primary endpoint was a stroke, myocardial infarction, symptoms leading to coronary or carotid revascularisation, or cardiovascular death.

This study supports the use of intensive medical therapy for patients with a recent stroke or TIA. Although the premature termination of the trial reduced its statistical power, the results are consistent with meta-analyses of previous cholesterol treatment trials. Therefore, following an ischaemic stroke or TIA, an LDL target of (70 mg/dL should be the goal.

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