Abstract WP194: Ldlc Levels, Lipid Lowering Treatment And Recurrent Stroke In Minor Ischemic Stroke Or Tia

Objective: 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 ischemic stroke or transient ischemic attack (TIA). Methods: We derived data from the Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial. Patients with a minor stroke or TIA were categorized by LDL-C level at baseline (<100 or ≥100 mg/dL [2.6 mmol/L]) and with or without lipid lowering treatment after symptom onset. The primary outcome was a new ischemic stroke at 3 months. The association of baseline LDL-C level and effect of lowering treatment were assessed. Results: Among 3,027 patients, 2,154(71.2%) patients had an initial LDL-C ≥100 mg/dL, of which 1,267(41.9%) received lipid lowering treatment. Elevated LDL-C level was associated with a higher risk of new ischemic stroke at 3 months in patients without lipid lowering treatment (adj.HR=1.35, 95%CI: 1.19-1.53), but not in those with lipid lowering treatment (adj.HR=0.99, 95%CI: 0.82-1.19) (p for interaction=0.007). Patients with LDL-C ≥100 mg/dL had a trend towards higher risk of ischemic stroke (11.8% vs. 8.0%, adj.HR=1.37, 95%CI: 0.96-1.96) in those without lipid lowering treatment. For patients with LDL-C ≥100 mg/dL, lipid lowering treatment was associated with reduced risk of ischemic stroke at 3 months (7.9% vs. 11.8%; adj.HR=0.54, 95%CI: 0.39-0.75). Conclusions: Elevated untreated baseline LDL-C level was associated with an increased short-term risk of ischemic stroke among patients presenting with minor ischemic stroke or TIA. There was potential benefit of lipid lowering treatment in stroke patients.