Sustained LDL-C target attainment and recurrent ischemic cerebrovascular events after ischemic stroke: effect modification by large-artery disease.

Authors

Xiaofeng Zhang, Di Niu, Yikang Li, Yuanyuan Wang, Ruizhi Chen, Guoping Xing

Published in

Frontiers in neurology. Volume 17. Pages 1902614. Epub Aug 27, 2026.

Abstract

In secondary prevention after ischemic stroke or TIA, LDL-C < 1.8 mmol/L is associated with a lower risk of recurrent vascular events. However, evidence remains limited in real-world patients with ischemic stroke, especially those with significant large-artery atherosclerotic stenosis. In particular, few studies have evaluated the impact of sustained LDL-C target attainment on recurrent ischemic cerebrovascular events by using LDL-C target attainment as a time-varying exposure.
We retrospectively studied 933 patients with ischemic stroke who had baseline LDL-C levels ≥1.8 mmol/L at admission. Significant large-artery disease (LAD) was defined as ≥50% intracranial or extracranial atherosclerotic stenosis. LDL-C target attainment was defined as <1.8 mmol/L. The primary outcome was recurrent ischemic cerebrovascular events. Time-dependent Cox models evaluated the association between time-varying LDL-C target attainment and recurrence, and effect modification by LAD status was assessed. The proportion of follow-up time with LDL-C ≥ 1.8 mmol/L was additionally assessed.
Among 933 patients, 369 had LAD and 564 did not. During follow-up, 102 recurrent ischemic cerebrovascular events occurred. In the fully adjusted model, time-varying LDL-C target attainment was associated with lower recurrence risk [hazard ratio (HR) = 0.399, 95% confidence interval (CI): 0.269-0.593, p < 0.001]. This association was stronger in patients with LAD (HR = 0.282, 95% CI: 0.168-0.475, p < 0.001) than in those without LAD (HR = 0.530, 95% CI: 0.288-0.976; p = 0.042; P for interaction = 0.041). Each 10% increase in the proportion of follow-up time with LDL-C ≥ 1.8 mmol/L was associated with higher recurrence risk (HR = 1.189, 95% CI 1.127-1.254), with a stronger association in LAD patients (P for interaction = 0.008).
Among patients with ischemic stroke who had baseline LDL-C levels ≥1.8 mmol/L at admission, sustained LDL-C target attainment was associated with a lower risk of recurrence after ischemic stroke. This association was particularly evident in patients with significant LAD. Sustained LDL-C control may support risk stratification and secondary prevention.

PMID:
42723896
Bibliographic data and abstract were imported from PubMed on 11 Sep 2026.

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