Achieved low-density lipoprotein cholesterol level and stroke risk: A meta-analysis of 23 randomised trials
- Authors
- Shin, Jaewon; Chung, Jong-Won; Jang, Hyun-Soon; Lee, Juneyoung; Hong, Keun-Sik; Bang, Oh Young; Kim, Gyeong-Moon; Seo, Woo-Keun
- Issue Date
- 8월-2021
- Publisher
- OXFORD UNIV PRESS
- Keywords
- Stroke; LDL-cholesterol; statin; PCSK9 inhibitor; meta-analysis
- Citation
- EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY, v.28, no.8, pp.905 - 916
- Indexed
- SCIE
SCOPUS
- Journal Title
- EUROPEAN JOURNAL OF PREVENTIVE CARDIOLOGY
- Volume
- 28
- Number
- 8
- Start Page
- 905
- End Page
- 916
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/137061
- DOI
- 10.1177/2047487319830503
- ISSN
- 2047-4873
- Abstract
- Aims Lowering the low-density lipoprotein cholesterol level reduces the risk of stroke, but it has not been clear whether the stroke risk would continuously decrease by lowering low-density lipoprotein cholesterol to a very low level. The purpose of this study was to evaluate the association between achieved low-density lipoprotein cholesterol levels and stroke risk. Methods and results A systematic search of MEDLINE, EMBASE and Cochrane Library databases was conducted to identify randomised controlled trials that tested cholesterol-lowering pharmacological therapies and reported both achieved low-density lipoprotein cholesterol levels and stroke outcomes. A meta-regression analysis was conducted to assess the linear association between the achieved low-density lipoprotein cholesterol levels and stroke risk. In addition, we evaluated pooled estimates of low-density lipoprotein cholesterol-lowering effect stratified by achieved low-density lipoprotein cholesterol levels of active arms. A total of 222,149 participants in 23 trials (52 arms of 26 studies) were included. The meta-regression analysis showed that each 1 mmol/L decrease in the achieved low-density lipoprotein cholesterol level (down to 0.78 mmol/L) was associated with a significant reduction of 23.5% (slope 0.235, 95% confidence interval 0.007-0.464, P = 0.044) in stroke risk. Irrespective of achieved low-density lipoprotein cholesterol levels in the active arms, the effects of lowering the low-density lipoprotein cholesterol level on stroke risk were significant and consistent (test for subgroup difference, P = 0.23, I-2 = 31%). However, there was no significant increase in haemorrhagic stroke risk with lower achieved low-density lipoprotein cholesterol levels. Conclusion In this meta-analysis of randomised controlled trials, the stroke risk monotonically reduced with lowering of low-density lipoprotein cholesterol to very low levels.
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