Lower target LDL after stroke prevents 25% of events at 5 years

I have no clue what mine is or was, the doctor rattles off some numbers assuming I know what is being talked about. Do you really think your hospital will pick up on this and create a protocol for it?

Lower target LDL after stroke prevents 25% of events at 5 years

During the 5 years after a stroke, targeting LDL of less than 70 mg/dL prevented more than one-quarter of major CV events, recurrent cerebral infarction or urgent carotid revascularization and recurrent cerebral infarction or hemorrhage vs. an LDL target of less than approximately 100 mg/dL.
According to new data from the Treat Stroke to Target trial presented at the International Stroke Conference, the target LDL of less than 70 mg/dL in the 5-year period after stroke was associated with lower risk for the primary endpoint of stroke, MI, new symptoms requiring urgent coronary or carotid revascularization and CV death compared with target LDL of less than 100 ± 10 mg/dL (9.6% vs. 12.9%; HR = 0.74; 95% CI, 0.75-0.94).

The lower target LDL was also associated with reductions in cerebral infarction or urgent carotid revascularization (27%; P = .046), cerebral infarction or intracranial hemorrhage (28%; P = .023), and the primary outcome plus intracranial hemorrhage (25%; P = .022) vs. the higher target LDL.
The findings were simultaneously published in Stroke.
“In patients with ischemic stroke associated with atherosclerotic disease, as compared to a target LDL of 100 mg/dL, targeting LDL of less than 70 mg/dL during 5.3 years avoided one subsequent major vascular event in four and one ischemic stroke or intracranial hemorrhage in four without increasing the risk of intracranial hemorrhage, with a number needed to treat of 30, meaning that if you treat 30 patients you will avoid one stroke,” Pierre Amarenco, MD, of the department of neurology and stroke center at Bichat Hospital, University of Paris, said during the presentation. “This is a very important achievement for future guidelines.”
In other findings, intracranial hemorrhages occurred in 1.2% of patients assigned to LDL less than 70 mg/dL and in 1% of patients assigned to LDL less than 100 ± 10 mg/dL (HR = 1.17; 95% CI, 0.53-2.62).
Patients with proven ischemic stroke
“In a subanalysis, we found a strange result in patients with proven ischemic stroke, having a 37% relative risk reduction and no apparent benefit in patients with transient ischemic attack, that is, no ischemia proven on a brain imaging, with a significant interaction. It’s difficult to explain that,” Amarenco said during his presentation. “Perhaps there is too much noise in the diagnosis of transient ischemic attacks. This is possible and, in future trials, we should concentrate on patients with proven ischemic stroke.”

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Perspective

Larry B. Goldstein

The primary report was published in the New England Journal of Medicine earlier this year and showed the benefit of treatment with a statin targeting an LDL of approximately 70 mg/dL compared with 100 mg/dL on reducing major vascular events in participants who had an ischemic stroke or TIA related to atherosclerosis within the prior 3 months (22% reduction). The trial was conducted in France and Korea, which started enrollment later and where follow up was shorter (5.3 vs. 2 years).  Although there was no statistical heterogeneity based on country, there was no significant benefit in Korea. An exploratory analysis focused on France found a 26% reduction in major vascular events. The participants from Korea will continue to be followed to determine whether they also benefit. Overall, the results are consistent with exploratory analyses of the SPARCL trial that found a greater benefit with achieving an LDL of approximately 70 mg/dL and support this therapeutic target.

• Larry B. Goldstein, MD, FAAN, FANA, FAHA
• Cardiology Today Editorial Board Member
  University of Kentucky