NEW YORK (Reuters Health) – The optimal LDL-cholesterol level for preventing stroke recurrence appears to be between 80 and 100 mg/dL, researchers from Japan report.
“This post hoc analysis revealed potent differences in the influences of LDL-cholesterol levels and statin treatments on stroke subtypes,” said Dr. Naohisa Hosomi from Hiroshima University Graduate School of Biomedical and Health Sciences.
“For the prevention of stroke and transient ischemic attack (TIA) incidence with statins, clinicians should consider the most likely stroke subtype in each patient when determining the desirable LDL-cholesterol level to be achieved by statin treatment,” he told Reuters Health by email.
Meta-analyses have shown that the risk reduction for primary stroke prevention depends on the degree of LDL-cholesterol reduction with statins, but the optimal LDL-cholesterol level for the prevention of stroke recurrence remains uncertain.
Dr. Hosomi and colleagues sought to determine desirable LDL-cholesterol levels for preventing stroke recurrence overall and among stroke subtypes in their post hoc analysis of the Japan Statin Treatment Against Recurrent Stroke (J-STARS) study.
The adjusted risks for stroke and TIA and for all vascular events was lowest among individuals who achieved post-randomized LDL cholesterol levels between 80 and 100 mg/dL, the team reports in Stroke, online March 6.
There were too few patients who achieved LDL cholesterol levels below 80 mg/dL to determine whether their risk of recurrent stroke was even lower.
The risks for stroke and TIA, all vascular events, and stroke were not related to the magnitude of LDL-cholesterol reduction achieved below baseline levels.
Results differed according to stroke subtypes. The risk of atherothrombotic infarction was lowest for patients with baseline LDL-cholesterol levels between 140 and 160 mg/dL, but was not related to levels achieved after randomization or to the magnitude of the LDL-cholesterol reduction.
The risk of intracranial hemorrhage did not differ with baseline or post-randomization LDL cholesterol or with the degree of LDL-cholesterol reduction.
The risk of lacunar infarction was lowest for patients who achieved LDL cholesterol levels between 100 and 120 mg/dL post-randomization. The risk did not differ significantly with baseline LDL-cholesterol level or with the degree of LDL-cholesterol reduction.
Dr. Erin Bohula May from TIMI Study Group, Brigham and Women’s Hospital, in Boston, told Reuters Health by email, “There is a large body of data suggesting that aggressive lipid lowering is beneficial for reduction in ischemic stroke in the primary and secondary populations.”
“Taken together, these findings suggest to me that lower is better in terms of goal LDL cholesterol (LDL-C) and that we haven’t defined a range yet where there is no further benefit in terms of stroke prevention with lipid lowering therapy,” she said. “So, based on the other data out there, I am hesitant to recommend a target range as high as 80-100 mg/dL for stroke prevention, but would rather suggest driving the LDL-C as low as possible and certainly below 70 mg/dL.”
Five of the 12 authors have had various relationships with Daiichi Sankyo Co., Ltd., which sells pravastatin, the drug used in J-STARS.
SOURCE: http://bit.ly/2u0tMgj
Stroke 2018.
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