@article{Monguillon:2026:10.1161/CIRCULATIONAHA.125.077549,
author = {Monguillon, V and Kelly, PJ and O'Donoghue, ML and Park, J-G and Bohula, EA and Saver, JL and Atar, D and Keech, AC and Sever, PS and Wang, H and Paiva, da Silva Lima G and Sabatine, MS and Giugliano, RP},
doi = {10.1161/CIRCULATIONAHA.125.077549},
journal = {Circulation},
pages = {86--93},
title = {Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke.},
url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.125.077549},
volume = {153},
year = {2026}
}

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TY  - JOUR
AB  - 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, includi
AU  - Monguillon,V
AU  - Kelly,PJ
AU  - O'Donoghue,ML
AU  - Park,J-G
AU  - Bohula,EA
AU  - Saver,JL
AU  - Atar,D
AU  - Keech,AC
AU  - Sever,PS
AU  - Wang,H
AU  - Paiva,da Silva Lima G
AU  - Sabatine,MS
AU  - Giugliano,RP
DO  - 10.1161/CIRCULATIONAHA.125.077549
EP  - 93
PY  - 2026///
SP  - 86
TI  - Efficacy and Safety of Very Low Achieved LDL Cholesterol in Patients With Previous Ischemic Stroke.
T2  - Circulation
UR  - http://dx.doi.org/10.1161/CIRCULATIONAHA.125.077549
UR  - https://www.ncbi.nlm.nih.gov/pubmed/41178569
VL  - 153
ER  - 

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