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Dr. Richard Shek-Kwan Chang, 11 Oct 2018
A 38-year-old right-handed man had had epilepsy since 2 months of age. There was no relevant family history. Perinatal history was unremarkable. No other risk factors such as central nervous system infection or cerebral trauma were identified. Developmental history did not show major delay. His epilepsy was uncontrolled despite trying valproate, carbamazepine, clobazam, levetiracetam, oxcarbamazepine and perampanel. 

Lower cholesterol targets after stroke may reduce subsequent major vascular events

29 Mar 2020

Targeting a low-density lipoprotein (LDL) cholesterol level <70 mg/dL following an ischaemic stroke of atherosclerotic origin helps to avoid one in four subsequent major vascular events without increasing the risk of intracranial haemorrhage over about 5 years of follow-up, according to data from the Treat Stroke to Target (TST) trial.

TST randomly assigned 2,148 ischaemic stroke patients with atherosclerotic stenosis of cerebral vasculature or aortic arch plaque >4 mm to a target LDL cholesterol of <70 mg/dL (1.8 mmol/L; n=1,073) or 100±10 mg/dL (2.3–2.8 mmol/L; n=1,075). All patients received intense or moderate dose of statin with or without ezetimibe.

There were no significant between-group differences in age (mean, 67 years) and baseline LDL cholesterol (mean, 137 mg/dL). The primary outcome was the composite of ischaemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death.

After a median follow-up of 5.3 years, the achieved LDL cholesterol was 66 mg/dL in the lower-target group and 96 mg/dL in the higher-target group. A lower LDL cholesterol target resulted in fewer composite outcome events (9.6 percent vs 12.9 percent; hazard ratio [HR], 0.74, 95 percent confidence interval [CI], 0.57–0.94; p=0.019).

Additionally, a target LDL cholesterol of <70 vs 100±10 mg/dL cut the risks of cerebral infarction or urgent carotid revascularization following transient ischaemic attack by 27 percent (p=0.046), cerebral infarction or intracranial haemorrhage by 28 percent (p=0.023), and the primary outcome or intracranial haemorrhage by 25 percent (p=0.021).

Safety outcome did not significantly differ between the lower- and higher-target groups, with intracranial haemorrhage occurring in 13 and 11 patients, respectively (HR, 1.17, 95 percent CI, 0.53–2.62; p=0.70).

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Most Read Articles
Dr. Richard Shek-Kwan Chang, 11 Oct 2018
A 38-year-old right-handed man had had epilepsy since 2 months of age. There was no relevant family history. Perinatal history was unremarkable. No other risk factors such as central nervous system infection or cerebral trauma were identified. Developmental history did not show major delay. His epilepsy was uncontrolled despite trying valproate, carbamazepine, clobazam, levetiracetam, oxcarbamazepine and perampanel.