Low-Density Lipoprotein Cholesterol Level After a Stroke

Randomized clinical trials (RCTs) of statins as the primary prevention for patients with a high serum low-density lipoprotein cholesterol (LDL-C) level and as the secondary prevention after an acute coronary event have shown that lowering serum LDL-C levels reduces the risks of myocardial infarction, stroke, and vascular death. These trials included stroke as a secondary end point but not as an entry criterion. The benefit of LDL-C lowering to reduce the risk of ischemic strokes in primary prevention trials and for patients with coronary heart disease is not necessarily seen among patients who have had a stroke. The Stroke Prevention by Aggressive Reduction in Cholesterol Level (SPARCL) trial, conducted for patients with stroke, no known coronary heart disease, and an LDL-C level higher than 100 mg/dL (to convert to millimoles per liter, multiply by 0.0259), found a 16% lower incidence of recurrent stroke among patients who received 80 mg/d of atorvastatin compared with those who received placebo, despite small increased risks of de novo type 2 diabetes and hemorrhagic stroke. In a subgroup of patients with carotid stenosis, a 33% lower incidence of stroke was found in this trial among the group that received atorvastatin. Two important questions remained unanswered after the SPARCL trial: (1) Is the benefit of atorvastatin, 80 mg/d, due to LDL-C lowering or a pleiotropic effect of atorvastatin? (2) To what level should LDL-C be lowered?
Source: JAMA Neurology - Category: Neurology Source Type: research