# Effectiviteit en veiligheid van zeer laag bereikt LDL na ischemisch CVA

*geplaatst 2026-01-13 · Cholesterol · Circulation · doi 10.1161/CIRCULATIONAHA.125.077549 · https://hartvaat.nl/2026/01/13/effectiviteit-en-veiligheid-van-zeer-laag-bereikt-ldl-na-ischemisch-cva/*

Analyse onderzocht de veiligheid van zeer lage LDL-waarden (<30 mg/dL) bij patiënten na ischemisch CVA. Er was geen toename van bijwerkingen, wat agressieve LDL-verlaging bij cerebrovasculaire ziekte ondersteunt.

## English: Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke.

This analysis confirmed the safety and cardiovascular benefit of achieving very low LDL cholesterol levels (<30 mg/dL) in patients after ischemic stroke, with no increase in hemorrhagic stroke or other adverse events at the lowest LDL levels.

## Abstract (original, from the publication)

BACKGROUND: Patients with previous ischemic stroke are at high risk for recurrent stroke and other major adverse cardiovascular events. The benefits of achieving very low levels of low-density lipoprotein cholesterol (LDL-C) in such patients is unclear. METHODS: We analyzed patients with previous ischemic stroke enrolled in FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk), a randomized placebo-controlled trial studying evolocumab in patients with stable atherosclerotic cardiovascular disease (median follow-up, 2.2 years), and through the open-label extension (FOURIER-OLE) period (additional median follow-up, 5 years), to examine the relationship between achieved LDL-C and the long-term incidence of the primary end point (cardiovascular death, myocardial infarction, stroke, or hospitalization for unstable angina or coronary revascularization) and stroke-related end points. RESULTS: The analysis included 5291 patients with previous ischemic stroke (>4 weeks). Of these, 666 (12.6%), 1410 (26.6%), 586 (11.1%), 508 (9.6%), and 2121 (40.1%) patients achieved LDL-C values of <20, 20 to <40, 40 to <55, 55 to <70, and ≥70 mg/dL, respectively. The incidence of the primary end point, all stroke, and ischemic stroke each decreased in a monotonic fashion with lower achieved LDL-C levels on a continuous scale (Ptrend<0.001, 0.002, and 0.002, respectively). Compared with patients with LDL-C ≥70 mg/dL, those who achieved levels <40 mg/dL had incidence rate ratios of 0.69 (95% CI, 0.57-0.84), 0.73 (95% CI, 0.53-0.99), and 0.75 (95% CI, 0.54-1.05) for the outcomes of the primary end point, all stroke, and ischemic stroke, respectively. Hemorrhagic strokes were infrequent and unrelated to achieved LDL-C (Ptrend=0.85). CONCLUSIONS: In patients with previous ischemic stroke, it appeared that the lower the LDL-C, down to levels <40 mg/dL, the lower the risk of major adverse cardiovascular events, including recurrent stroke, without a clear increase in risk of hemorrhagic stroke. These findings support the concept that more intensive LDL-C lowering in patients with previous ischemic stroke may be warranted. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01764633/NCT01764633.

Auteurs: Victorien Monguillon, Peter J Kelly, Michelle L O'Donoghue, Jeong-Gun Park, Erin A Bohula, Jeffrey L Saver, Dan Atar, Anthony C Keech, Peter S Sever, Huei Wang, Gabriel Paiva da Silva Lima, Marc S Sabatine, Robert P Giugliano

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.125.077549. Bijgewerkt 2026-07-03T13:31:05Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.