Relationship between Low-Density Lipoprotein Cholesterol, Lipid Lowering Agents and the Risk of Stroke: A meta-analysis of Observational studies (n=355,591) and Randomized Controlled Trials (n=165,988).

Banach, Maciej; Shekoohi, Niloofar; Mikhailidis, Dimitri P.; Lip, Gregory Y. H.; Hernandez, Adrián V.; Mazidi, Mohsen

doi:10.5114/aoms/145970

Cited by 11 publications

(11 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results of the REALITY cohort study, performed in 2019 based on the nationwide database with real-life Spanish patients, confirmed that only about 3% of individuals achieve the LDL-C target of less than 55 mg/dl (1.4 mmol/l) and less than 15% of ASCVD patients reach the goal of <70 mg/dl (1.8 mmol/l) 9 . This study again confirmed that the largest unmet needs refer to patients with stroke/transient ischemic attack (TIA) and PAD, for whom the 24-month mortality rate was between 10.2-11.9% [9][10][11] .…”

supporting

confidence: 66%

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

et al. 2022

Self Cite

View full text Add to dashboard Cite

Recent data clearly show that we are extremely ineffective in the use of lipid-lowering therapy (LLT). Furthermore, the problem seems to be the most serious in the group of patients at very high and extremely high-riskthe patients who stand to benefit most from effective therapy 1 . The results of the DaVinci study showed that the proportion of very high-risk patients reaching the low-density lipoprotein cholesterol (LDL-C) goal (<55 mg/dl; 1.4 mmol/l) is only

show abstract

supporting

confidence: 66%

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

et al. 2022

Self Cite

View full text Add to dashboard Cite

show abstract

“…In the most recent meta-analysis of the observational studies ( n = 355 591) and RCTs ( n = 165 988), the authors showed that lipid-lowering agents (LLAs = statins + non-statin therapies) decreased the risk of all types of strokes (ischaemic, haemorrhagic strokes, ICH, intraparenchymal haemorrhage, cerebral infarction, and cerebral haemorrhage) for those who achieved LDL-C < 1.8 mmol/L [<70 mg/dL; RR = 0.88, 0.80–0.96, aRR: 0.7%, number needed to treat (NNT): 143]. 11 Statin therapy decreased the risk of all strokes (RR = 0.88, 0.80–0.97, aRR: 0.6%, NNT: 167), and with regard to ischaemic stroke only LLAs decreased the risk by 25% for those who achieved LDL-C <1.8 mmol/L (<70 mg/dL; RR = 0.75, 0.67–0.83, aRR: 1.3%, NNT: 77); the same was observed for statins (RR = 0.76, 0.69–0.84, aRR: 1.3%, NNT: 77). No significant link was found between LDL-C levels and ICH events (HR: 0.99, 0.77–1.28, P = 1.0).…”

Section: Current Opinionmentioning

confidence: 99%

“…The authors did not also show any significant effect of LLAs regardless of the achieved level of the LDL-C on the risk of haemorrhagic stroke. 11 …”

Section: Current Opinionmentioning

confidence: 99%

Low levels of low-density lipoprotein cholesterol, intracerebral haemorrhage, and other safety issues: is there still a matter of debate?

Sabouret

Angoulvant

Cannon

et al. 2022

European Heart Journal Open

Self Cite

View full text Add to dashboard Cite

Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebral hemorrhage (ICH), these analyzes have issues of confounding where other factors (e.g., older age, frailty) that likely explain the findings, and the number of events was very low. More recent results from randomized clinical trials have not found an increased risk in ICH, most notably trials using PCSK9 inhibitors that achieve very low levels of LDL-C, but also in the long-term follow-up of the IMPROVE-IT trial. Also, other statin-associated safety issues, including new onset diabetes (NOD) and the cancer risk should not be the reason of statin discontinuation, especially for the former the benefits highly outweigh the risk (even 5x), and for the latter there is no confirmed link suggesting any increased risk, in opposite, data exist suggesting benefits of statin therapy in cancer prevention. Furthermore, use of intensive lipid lowering strategies with statins, and non-statin drugs lead to decrease of ischemic major adverse cardiac events (MACE), without safety concern, in a large population of atherosclerotic cardiovascular disease (ASCVD) patients. These data should promote the concept “the earlier, the lower, the longer, the better” for the lipid management of ASCVD patients. While few uncertainties remain in several populations that have been underrepresented in clinical trials (African American and Asian patients, low weight individuals), the most recent data with intensive LDL-C lowering with PCSK9 inhibitors are reassuring that the benefit outweighs any possible risk.

show abstract

“…The newly proposed conceptual framework for addressing residual atherosclerotic cardiovascular diseases risk in the era of precision medicine propose 5 broad residual risk targets: lipoproteins, inflammation, metabolism, platelets, and coagulation 6 . Among them, low-density lipoprotein cholesterol (LDL-C) is the main etiological risk factor of atherosclerotic cardiovascular disease, including ischemic stroke caused by ICAS 7 . Therefore, lowering LDL level has become an important risk factor for preventing recurrence and improving prognosis of patients with ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis

Shen

Wang

et al. 2023

The Neurologist

View full text Add to dashboard Cite

Background: It is unknown whether plasma low-density lipoprotein-cholesterol level (LDL-C) can predict the occurrence of intracranial atherosclerotic stenosis (ICAS), especially asymptomatic (A)ICAS. This study investigated whether LDL-C level is independently associated with AICAS. Methods: The Asymptomatic Polyvascular Abnormalities Community study is an ongoing community-based, prospective, long-term follow-up observational study with 3387 participants. AICAS was diagnosed by transcranial Doppler ultrasonography. The participants were divided into 3 groups based on LDL-C level. Cox regression was used to evaluate the association between LDL-C level and incidence of AICAS. Results: During 2 years of follow-up, 9.98% of participants were diagnosed with AICAS. The incidence of AICAS (person-years with 95% CI) was 4.99% (4.48%-5.50%). AICAS incidence did not increase with increasing LDL-C level. Compared with the <2.6 mmol/l subgroup, the incidence of asymptomatic ICAS was not significantly higher in the 2.6 to 3.4 and >3.4 mmol/l subgroups after adjusting for confounding factors (hazard ratio=0.95, 95% CI: 0.86-1.03 and hazard ratio=0.96, 95% CI: 0.84-1.10, respectively). Conclusions: LDL-C is not an independent predictor of AICAS incidence in the Chinese population.

show abstract

Relationship between Low-Density Lipoprotein Cholesterol, Lipid Lowering Agents and the Risk of Stroke: A meta-analysis of Observational studies (n=355,591) and Randomized Controlled Trials (n=165,988).

Cited by 11 publications

References 106 publications

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

Low levels of low-density lipoprotein cholesterol, intracerebral haemorrhage, and other safety issues: is there still a matter of debate?

Association Between Low-Density Lipoprotein-Cholesterol Level and Risk of Intracranial Atherosclerotic Stenosis

Contact Info

Product

Resources

About