LDL-C levels,lipid-lowering treatment and recurrent stroke in minor ischaemic stroke or TIA

Background and purpose Dyslipidaemia is a major risk factor for ischaemic stroke and transient ischaemic attack(TIA).This study aimed to investigate the association between baseline low-density lipoprotein cholesterol(LDL-C)level,lipid-lowering treatment and short-term risk of new stroke in patients with a minor ischaemic stroke or TIA.Methods We derived data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events trial.Patients with a minor stroke or TIA were categorised by LDL-C level at baseline(<2.6 or≥2.6 mmol/L(100 mg/dL))and with or without lipid-lowering treatment after symptom onset.The primary outcome was a new ischaemic stroke at 3 months.The association of baseline LDL-C level,lowering treatment and outcomes were assessed.Results Among 3027 patients,2154(71.2%)patients had an initial LDL-C≥2.6 mmol/L,of which 1267(41.9%)received lipid-lowering treatment.Elevated LDL-C level was associated with a higher risk of new ischaemic stroke at 3 months in patients without lipid-lowering treatment(adj.HR=1.35,95%CI:1.19 to 1.53),but not in those with lipid-lowering treatment(adj.HR=0.99,95%CI:0.82 to 1.19)(p for interaction=0.007).Patients with LDL-C≥2.6 mmol/L had a numerically higher risk of ischaemic stroke(11.8%vs 8.0%,adj.HR=1.37,95%CI:0.96 to 1.96)in those without lipid-lowering treatment.For patients with LDL-C≥2.6 mmol/L,lipid-lowering treatment was associated with reduced risk of ischaemic stroke at 3 months(7.9%vs 11.8%;adj.HR=0.54,95%CI:0.39 to 0.75).Conclusions Elevated untreated baseline LDL-C level was associated with an increased short-term risk of ischaemic stroke among patients presenting with minor ischaemic stroke or TIA.There was potential benefit of lipid-lowering treatment in minor stroke or TIA patients with LDL-C≥2.6 mmol/L.Trial registration number NCT00979589.