Effect of a ≥50% Reduction in Low-Density Lipoprotein Cholesterol From Baseline in Patients With Ischemic Stroke.

Authors

Minyoul Baik, Jimin Jeon, Joonsang Yoo, Jinkwon Kim

Published in

Neurology. Volume 107. Issue 6. Pages e218491. Sep 22, 2026. Epub Aug 20, 2026.

Abstract

Current secondary atherosclerotic cardiovascular disease prevention guidelines recommend both a ≥50% reduction in low-density lipoprotein cholesterol (LDL-C) from baseline and an absolute LDL-C goal (<70 or <55 mg/dL). Stroke-specific guidelines primarily emphasize only an absolute LDL-C goal, and the independent clinical impact of achieving a ≥50% reduction remains unclear in patients with ischemic stroke. This study aimed to evaluate whether achieving a ≥50% LDL-C reduction provides prognostic benefit independent of attaining an absolute LDL-C goal in patients with ischemic stroke.
This retrospective cohort study included patients admitted for acute ischemic stroke (2014-2022) using the Korean National Health Insurance Database in South Korea. LDL-C status over time was derived from serial national health examinations following the index stroke. Patients were categorized into 4 groups according to attainment of absolute (<70 mg/dL) and relative (≥50% reduction from baseline) LDL-C goals. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause death, analyzed using time-varying Cox regression.
Among 89,414 patients, 136,427 poststroke LDL-C measurements were analyzed over a mean follow-up of 5.72 ± 2.40 years. Throughout the follow-up period, the proportion of patients achieving a ≥50% LDL-C reduction from baseline remained at approximately 30%. Using the optimal group (achieving both <70 mg/dL and ≥50% reduction) as the reference, the risk of the primary outcome was significantly higher in groups failing to achieve a ≥50% reduction, regardless of attainment of the absolute LDL-C level (<70 mg/dL): adjusted hazard ratio [95% CI] 1.12 [1.06-1.18] for the <70 mg/dL and <50% reduction group and 1.28 [1.23-1.34] for the ≥70 mg/dL and <50% reduction group. Results were consistent across subgroups stratified by sex, age, baseline LDL-C level, and the presence of presumed cardioembolic source.
Achieving a ≥50% reduction in LDL-C from baseline was independently associated with a lower risk of secondary cardiovascular events. A substantial proportion of patients with ischemic stroke fail to achieve optimal LDL-C reduction; thus, more intensive and multifaceted lipid-lowering strategies focusing on both absolute and relative LDL-C reduction may lead to improved long-term outcomes.

PMID:
42623575
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.

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