{"id":"f9509e699108","type":"article","url":"https://hartvaat.nl/2026/09/22/ldl-c-reductie-50-verlaagt-risico-op-secundaire-cardiovasculaire-gebeurtenissen-/","title":"LDL-C-reductie ≥50% verlaagt risico op secundaire cardiovasculaire gebeurtenissen na ischemische stroke","title_en":"Effect of a ≥50% Reduction in Low-Density Lipoprotein Cholesterol From Baseline in Patients With Ischemic Stroke.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Neurology","doi":"10.1212/WNL.0000000000218491","source_url":"https://doi.org/10.1212/WNL.0000000000218491","authors":["Minyoul Baik","Jimin Jeon","Joonsang Yoo","Jinkwon Kim"],"significance":5,"published":"2026-08-27","source_date":"2026-09-22","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/cardiovasculair-risico-begrippen/"],"congress":"","summary_en":"A retrospective cohort study of 89,414 patients following an acute ischemic stroke found that achieving a ≥50% reduction in LDL-C from baseline independently lowers the risk of recurrent stroke, myocardial infarction, and all-cause mortality, regardless of whether an absolute LDL-C target of <70 mg/dL is met. Patients failing to reach the relative reduction threshold had a significantly higher risk of the primary outcome (adjusted HR 1.12 if LDL-C was <70 mg/dL, and HR 1.28 if ≥70 mg/dL). These findings reinforce current guidelines advocating for intensive lipid-lowering strategies that target both absolute and relative LDL-C reductions to optimize secondary prevention in stroke survivors.","created":"2026-08-21T00:54:03Z","updated":"2026-08-21T00:54:03Z","licence":"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.","body_markdown":"In een retrospectieve cohortstudie van bijna 90.000 patiënten met een ischemische stroke bleek dat het behalen van een LDL-C-reductie van ≥50% ten opzichte van de baseline onafhankelijk van het absolute LDL-C-doel (<70 mg/dL) het risico op recidief stroke, myocardinfarct en overlijden verlaagt. Patiënten die niet aan de relatieve reductiedoelstelling voldeden, hadden een verhoogd risico (HR 1,12 bij LDL-C <70 mg/dL en HR 1,28 bij LDL-C ≥70 mg/dL). Deze bevindingen ondersteunen het belang van intensieve lipidendalingstherapie met focus op zowel een absoluut als een relatief LDL-C-doel bij secundaire preventie na een cerebrovasculair incident.","abstract_original":"BACKGROUND AND OBJECTIVES: Current secondary atherosclerotic cardiovascular disease prevention guidelines recommend both a ≥50% reduction in low-density lipoprotein cholesterol (LDL-C) from baseline and an absolute LDL-C goal (<70 or <55 mg/dL). Stroke-specific guidelines primarily emphasize only an absolute LDL-C goal, and the independent clinical impact of achieving a ≥50% reduction remains unclear in patients with ischemic stroke. This study aimed to evaluate whether achieving a ≥50% LDL-C reduction provides prognostic benefit independent of attaining an absolute LDL-C goal in patients with ischemic stroke. METHODS: This retrospective cohort study included patients admitted for acute ischemic stroke (2014-2022) using the Korean National Health Insurance Database in South Korea. LDL-C status over time was derived from serial national health examinations following the index stroke. Patients were categorized into 4 groups according to attainment of absolute (<70 mg/dL) and relative (≥50% reduction from baseline) LDL-C goals. The primary outcome was a composite of recurrent stroke, myocardial infarction, and all-cause death, analyzed using time-varying Cox regression. RESULTS: Among 89,414 patients, 136,427 poststroke LDL-C measurements were analyzed over a mean follow-up of 5.72 ± 2.40 years. Throughout the follow-up period, the proportion of patients achieving a ≥50% LDL-C reduction from baseline remained at approximately 30%. Using the optimal group (achieving both <70 mg/dL and ≥50% reduction) as the reference, the risk of the primary outcome was significantly higher in groups failing to achieve a ≥50% reduction, regardless of attainment of the absolute LDL-C level (<70 mg/dL): adjusted hazard ratio [95% CI] 1.12 [1.06-1.18] for the <70 mg/dL and <50% reduction group and 1.28 [1.23-1.34] for the ≥70 mg/dL and <50% reduction group. Results were consistent across subgroups stratified by sex, age, baseline LDL-C level, and the presence of presumed cardioembolic source. DISCUSSION: Achieving a ≥50% reduction in LDL-C from baseline was independently associated with a lower risk of secondary cardiovascular events. A substantial proportion of patients with ischemic stroke fail to achieve optimal LDL-C reduction; thus, more intensive and multifaceted lipid-lowering strategies focusing on both absolute and relative LDL-C reduction may lead to improved long-term outcomes."}