Suboptimal LDL-C Goal Attainment After Ischemic Stroke and TIA: Prevalence, Determinants, and Clinical Implications

TL;DR

Many patients fail to reach LDL-C targets after stroke or TIA, but high-intensity statins improve outcomes.

Contribution

Identifies determinants of LDL-C goal attainment and supports aggressive lipid-lowering strategies in post-stroke patients.

Findings

Only 9.9% of patients achieved the strictest LDL-C target (<55 mg/dL) within 12 months.

High-intensity statins significantly increased attainment of LDL-C goals like <70 mg/dL and ≥50% reduction.

Baseline LDL-C levels and statin intensity were key determinants of LDL-C reduction.

Abstract

Background: Achieving low-density lipoprotein cholesterol (LDL-C) goals is essential for secondary prevention after atherosclerotic ischemic stroke or transient ischemic attack (TIA). This study assessed the prevalence of LDL-C goal attainment and identified associated determinants post-ischemic stroke/TIA. Methods: A cohort of Thai patients discharged on statin therapy after admission with acute ischemic stroke or TIA was evaluated for LDL-C goal attainment within 12 months post-discharge. Logistic regression determines factors associated with LDL-C goal attainment, and the generalized linear model confirmed the association between covariates and LDL-C reduction. Results: Among 487 patients (85.8% with ischemic stroke), the prevalence of LDL-C goal attainment differed across LDL-C target levels: 9.9% for <55 mg/dL, 29.0% for <70 mg/dL, 70.4% for <100 mg/dL, and 17.5% for ≥50% reduction from baseline. Logistic regression identified high-intensity statins as a significant predictor of goal attainment at <70 mg/dL (OR 1.91, 95% CI 1.09–3.34), <100 mg/dL (OR 1.64, 95% CI 1.01–2.67), and ≥50% reduction (OR 2.32, 95% CI 1.14–4.73), but not <55 mg/dL (OR 1.65, 95% CI 0.72–3.79). In the generalized linear model, high-intensity statin and baseline LDL-C were significant determinants of LDL-C reduction. Conclusions: LDL-C target attainment after ischemic stroke/TIA is modest overall, and remains low for the more stringent targets (<55 mg/dL). High-intensity statins improve goal attainment and produce greater LDL-C reductions, supporting wider use of more aggressive lipid-lowering strategies in this high-risk population.

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