treatment after an ischemic stroke

In a new study, researchers compared two options for treatment after an ischemic stroke.

Ischemic stroke occurs when the arteries that supply blood to the brain are blocked and account for around 87 percent of all strokes. Transient Ischemic Attack (TIA) is a stroke that lasts for only a few minutes and happens when the blood supply to the brain is temporarily interrupted. Transient Ischemic Attack often acts as a warning sign that the person is at a risk of more serious strokes in the future.

The main cause of ischemic stroke is atherosclerosis, a disease in which fatty deposits build up in the blood vessels. High levels of Low-density lipid (LDL) cholesterol, also known as bad cholesterol, lead to atherosclerosis and increases the risk of a stroke. The American Heart Association and American Stroke Association recommended intensive therapy, using statin medication, to lower levels of LDL cholesterol after TIA and ischemic stroke. There are currently no guidelines that set a target level for LDL cholesterol to reduce the risk of cardiovascular events after a stroke.

A new study, published in The New England Journal of Medicine, compared two treatment options with different target levels for reducing LDL cholesterol after an ischemic stroke. In this study, researchers recruited over 2,800 patients from France and South Korea who had a recent ischemic stroke or TIA and with evidence of atherosclerosis for which they were treated with LDL cholesterol-lowering medications such as statin, ezetimibe, or both. Participants were assigned randomly to either the lower-target (LDL cholesterol target levels less than 70 mg per decilitre) or the higher-target (LDL cholesterol target levels between 90 mg and 110 mg/decilitre) groups. Follow-ups of patients were conducted every six months, at which point their LDL cholesterol levels were measured. If the cholesterol levels were found to be either above or below the assigned target level, then the researchers adjusted the patients’ treatment.

The study reports that patients in the lower-target group experienced fewer major cardiovascular events than those in the higher-target group. The findings suggest that after a TIA or ischemic stroke, a target LDL cholesterol level of less than 70 mg per decilitre is associated with a lower risk of developing future cardiovascular events in comparison to a target level between 90 mg and 110 mg per decilitre. The study suggests that the treatment after an ischemic stroke in which the target LDL cholesterol level is set below 70 mg per decilitre is superior. According to the researchers, future studies may involve testing treatment options in which target LDL cholesterol levels will be set below 50 mg per decilitre.

 

Written by Ranjani Sabarinathan, MSc

 

References:

Amarenco P, Kim JS, Labreuche J, et al. (2019). A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. The New England Journal of Medicine. doi: 10.1056/NEJMoa1910355

Ischemic Stroke (Clots) https://www.stroke.org/en/about-stroke/types-of-stroke/ischemic-stroke-clots

Transient Ischemic Attack Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Transient-Ischemic-Attack-Information-Page

Image by Bruno Glätsch from Pixabay

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