Prevention & lipidsSecondary analysis
Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke
- Secondary analysis of the FOURIER randomised trial and its open-label extension
- placebo-controlled
Authors' conclusion
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.
Study context
- Population
- Patients with previous ischemic stroke (>4 weeks) and stable atherosclerotic CVD in FOURIER (evolocumab vs placebo) and FOURIER-OLE
- Participants
- 5,291 patients
- Comparison
- Achieved LDL-C categories vs ≥70 mg/dL
- <20 mg/dLn = 666
- 20 to <40 mg/dLn = 1,410
- 40 to <55 mg/dLn = 586
- 55 to <70 mg/dLn = 508
- ≥70 mg/dLn = 2,121reference
- Primary endpoint
- CV death, MI, stroke, or hospitalization for unstable angina or coronary revascularization
- Follow-up
- Median 2.2 years (FOURIER) plus additional median 5 years (FOURIER-OLE)
Primary result
Primary end point
Incidence rate ratio
0.69
95% CI 0.57–0.84
<40 mg/dL vs ≥70 mg/dL
IRR 0.69 (95% CI 0.57–0.84)
As reported in the abstract
- Incidence decreased monotonically with lower achieved LDL-C (continuous scale)
- P for trend < 0.001
Further findings
| Outcome | IRR (95% CI) | |
|---|---|---|
| All stroke | 0.73 (0.53–0.99) | |
| Ischemic stroke | 0.75 (0.54–1.05) | |
| 0.512Incidence rate ratio (log scale) |
- All stroke — Incidence decreased monotonically with lower achieved LDL-C
- Ptrend 0.002
- Ischemic stroke — Incidence decreased monotonically with lower achieved LDL-C
- Ptrend 0.002
Safety
Hemorrhagic stroke
- Infrequent and unrelated to achieved LDL-C
- P for trend = 0.85
Original publication
Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke. Circulation. Published 3 November 2025. doi:10.1161/circulationaha.125.077549
Summarised from the published abstract; every number is checked against it