Achieving low density lipoprotein-cholesterol < 70 mg/dL may be associated with a trend of reduced progression of carotid artery atherosclerosis in ischemic stroke patients

Abstract

Objective To assess whether an intensive lipid-lowering strategy is more beneficial on atherosclerotic plaque progression in the stroke survivors. Methods We retrospectively assessed data that was prospectively collected on 106 ischemic stroke patients from one academic stroke center. Patients with various degrees of common carotid artery atherosclerosis were followed for one year. Patients were classified into intensive lipid-lowering therapy (ILLT) group if they achieve low-density lipoprotein cholesterol (LDL-c) < 70 mg/dL (n = 38) and conventional lipid-lowering therapy (CLLT) group if their LDL-c is within 70–120 mg/dL (n = 68) at end of one year. Carotid ultrasound was performed at baseline lipid-lowering therapy and at one year to characterize the plaques. Results Mean change in atherosclerotic plaque length was −1.4 mm (95% CI: [−4.1, 1, 2]; P = 0.27) in ILLT and 1.1 mm in CLLP group (95% CI: [−0.9, 3.1]; P = 0.27); no difference between groups (P = 0.40). Atherosclerotic plaque thickness decreased by 0.2 mm (95% CI: [−0.4, 0.03]; P = 0.09) in ILLT group; while in CLLT group, thickness increased by 0.02 mm after 1-year therapy (95%CI: [−0.1, 0.2]; P = 0.77); no difference between groups (P = 0.28). Conclusions Achieving LDL-c < 70 mg/dL in ischemic stroke patients was associated with a trend of reducing atherosclerotic plaque progression at one year. Future larger studies are warranted.

Expression of the C677T Polymorphism of the 5, 10-Methylenetetrahydrofolate Reductase (MTHFR) Gene in Patients with Carotid Artery Atherosclerosis

“…Further logistic regression analysis found that SBP increased the risk of carotid artery atherosclerosis by 3.514 times, suggesting that hypertension is an independent risk factor for carotid artery atherosclerosis, which is consistent with the literature [ 28 ]. TC and LDL-C are also risk factors for carotid artery atherosclerosis, and high levels of LDL can damage arterial endothelial cells, and lipid abnormalities make lipids easily deposited in blood vessels to form atheromatous plaques [ 29 ].…”

Progression of Mild to Moderate Stenosis in the Internal Carotid Arteries of Patients With Ischemic Stroke

“…Furberg et al showed that lovastatin therapy can regress intima thickening (16). Zhang et al found that decreasing lower low-density lipoprotein cholesterol levels to < 70 mg/dl can decrease plaque progression (17). We found that hyper-LDL-c increased the risk of stenosis progression but hypercholesterolemia do not affect the progression of carotid artery stenosis, and that statin use does not affect the progression of carotid artery stenosis in patients with and without hypercholesterolemia.…”

Search for Reliable Circulating Biomarkers to Predict Carotid Plaque Vulnerability

“…Several lines of evidence have demonstrated the role of LDLc concentration in stroke. For instance, high LDLc concentrations increase the risk of stenosis progression in symptomatic patients with mild to moderate stenosis [43], whereas reduction of TC and LDLc levels by an intensive lipid-lowering therapy reduces the recurrence and future cardiovascular events [118], as well as prevents the progression of carotid atherosclerosis in asymptomatic [119] and symptomatic patients [120]. Statins are the most widely used lipid-lowering treatment and it has been demonstrated that their use in patients with non-cardioembolic strokes (including small-vessel disease and atherothrombotic strokes) reduces the incidence of stroke recurrence and other cardiovascular events.…”