Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis
Background Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021855 |
| _version_ | 1827932165276434432 |
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| author | Kui‐Kai Lau Bryan J. Chua Alexander Ng Ian Yu‐Hin Leung Yuen‐Kwun Wong Anna Ho‐Yin Chan Yuen‐Kei Chiu Ariane Xia‐Wei Chu William C. Y. Leung Anderson Chun‐On Tsang Kay‐Cheong Teo Henry Ka‐Fung Mak |
| author_facet | Kui‐Kai Lau Bryan J. Chua Alexander Ng Ian Yu‐Hin Leung Yuen‐Kwun Wong Anna Ho‐Yin Chan Yuen‐Kei Chiu Ariane Xia‐Wei Chu William C. Y. Leung Anderson Chun‐On Tsang Kay‐Cheong Teo Henry Ka‐Fung Mak |
| author_sort | Kui‐Kai Lau |
| collection | DOAJ |
| description | Background Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings can be generalized to Asian patients, or that similar LDL‐C targets should be adopted in patients with stroke without significant atherosclerosis. Methods and Results We performed a prospective cohort study and recruited consecutive Chinese patients with ischemic stroke with magnetic resonance angiography of the intra‐ and cervicocranial arteries performed at the University of Hong Kong between 2008 and 2014. Serial postevent LDL‐C measurements were obtained. Risk of major adverse cardiovascular events in patients with mean postevent LDL‐C <1.80 versus ≥1.80 mmol/L, stratified by presence or absence of significant (≥50%) large‐artery disease (LAD) and by ischemic stroke subtypes, were compared. Nine hundred four patients (mean age, 69±12 years; 60% men) were followed up for a mean 6.5±2.4 years (mean, 9±5 LDL‐C readings per patient). Regardless of LAD status, patients with a mean postevent LDL‐C <1.80 mmol/L were associated with a lower risk of major adverse cardiovascular events (with significant LAD: multivariable‐adjusted subdistribution hazard ratio, 0.65; 95% CI, 0.42–0.99; without significant LAD: subdistribution hazard ratio, 0.53; 95% CI, 0.32–0.88) (both P<0.05). Similar findings were noted in patients with ischemic stroke attributable to large‐artery atherosclerosis (subdistribution hazard ratio, 0.48; 95% CI, 0.28–0.84) and in patients with other ischemic stroke subtypes (subdistribution hazard ratio, 0.64; 95% CI, 0.43–0.95) (both P<0.05). Conclusions A mean LDL‐C <1.80 mmol/L was associated with a lower risk of major adverse cardiovascular events in Chinese patients with ischemic stroke with and without significant LAD. Further randomized trials to determine the optimal LDL‐C cutoff in stroke patients without significant atherosclerosis are warranted. |
| first_indexed | 2024-03-13T07:05:44Z |
| format | Article |
| id | doaj.art-ae9b7250f947446487b1c1cd26f06c82 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-13T07:05:44Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-ae9b7250f947446487b1c1cd26f06c822023-06-06T12:10:51ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-08-01101610.1161/JAHA.121.021855Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant AtherosclerosisKui‐Kai Lau0Bryan J. Chua1Alexander Ng2Ian Yu‐Hin Leung3Yuen‐Kwun Wong4Anna Ho‐Yin Chan5Yuen‐Kei Chiu6Ariane Xia‐Wei Chu7William C. Y. Leung8Anderson Chun‐On Tsang9Kay‐Cheong Teo10Henry Ka‐Fung Mak11Division of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurosurgery Department of Surgery Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongDivision of Neurology Department of Medicine Queen Mary Hospital Li Ka Shing Faculty of Medicine University of Hong Kong Hong KongThe State Key Laboratory of Brain and Cognitive Sciences University of Hong Kong Hong KongBackground Recent trials have shown that low‐density lipoprotein cholesterol (LDL‐C) <1.80 mmol/L (<70 mg/dL) is associated with a reduced risk of major adverse cardiovascular events in White patients with ischemic stroke with atherosclerosis. However, it remains uncertain whether the findings can be generalized to Asian patients, or that similar LDL‐C targets should be adopted in patients with stroke without significant atherosclerosis. Methods and Results We performed a prospective cohort study and recruited consecutive Chinese patients with ischemic stroke with magnetic resonance angiography of the intra‐ and cervicocranial arteries performed at the University of Hong Kong between 2008 and 2014. Serial postevent LDL‐C measurements were obtained. Risk of major adverse cardiovascular events in patients with mean postevent LDL‐C <1.80 versus ≥1.80 mmol/L, stratified by presence or absence of significant (≥50%) large‐artery disease (LAD) and by ischemic stroke subtypes, were compared. Nine hundred four patients (mean age, 69±12 years; 60% men) were followed up for a mean 6.5±2.4 years (mean, 9±5 LDL‐C readings per patient). Regardless of LAD status, patients with a mean postevent LDL‐C <1.80 mmol/L were associated with a lower risk of major adverse cardiovascular events (with significant LAD: multivariable‐adjusted subdistribution hazard ratio, 0.65; 95% CI, 0.42–0.99; without significant LAD: subdistribution hazard ratio, 0.53; 95% CI, 0.32–0.88) (both P<0.05). Similar findings were noted in patients with ischemic stroke attributable to large‐artery atherosclerosis (subdistribution hazard ratio, 0.48; 95% CI, 0.28–0.84) and in patients with other ischemic stroke subtypes (subdistribution hazard ratio, 0.64; 95% CI, 0.43–0.95) (both P<0.05). Conclusions A mean LDL‐C <1.80 mmol/L was associated with a lower risk of major adverse cardiovascular events in Chinese patients with ischemic stroke with and without significant LAD. Further randomized trials to determine the optimal LDL‐C cutoff in stroke patients without significant atherosclerosis are warranted.https://www.ahajournals.org/doi/10.1161/JAHA.121.021855ischemic strokelow‐density lipoprotein cholesterolprognosisprospective cohort study |
| spellingShingle | Kui‐Kai Lau Bryan J. Chua Alexander Ng Ian Yu‐Hin Leung Yuen‐Kwun Wong Anna Ho‐Yin Chan Yuen‐Kei Chiu Ariane Xia‐Wei Chu William C. Y. Leung Anderson Chun‐On Tsang Kay‐Cheong Teo Henry Ka‐Fung Mak Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ischemic stroke low‐density lipoprotein cholesterol prognosis prospective cohort study |
| title | Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis |
| title_full | Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis |
| title_fullStr | Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis |
| title_full_unstemmed | Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis |
| title_short | Low‐Density Lipoprotein Cholesterol and Risk of Recurrent Vascular Events in Chinese Patients With Ischemic Stroke With and Without Significant Atherosclerosis |
| title_sort | low density lipoprotein cholesterol and risk of recurrent vascular events in chinese patients with ischemic stroke with and without significant atherosclerosis |
| topic | ischemic stroke low‐density lipoprotein cholesterol prognosis prospective cohort study |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021855 |
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