Cumulative Effects of LDL Cholesterol and CRP Levels on Recurrent Stroke and TIA

Aims: To investigate the relative contribution of on-treatment low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP) to the risk of recurrent stroke and transient ischemic attack (TIA) in patients with history of ischemic stroke. Methods: A total of 1095 patients with non-cardioembolic ischemic stroke were randomized into two groups: control and patients receiving 10 mg of pravastatin per day. After excluding 18 patients who did not have baseline CRP data, the effects of LDL cholesterol and CRP on recurrent stroke and TIA were prospectively assessed in 1077 patients. Results: During the follow-up of 4.9 +/- 1.4 years, there were 131 recurrent stroke or TIA cases. Patients with on-treatment LDL cholesterol < 120 mg/dL showed 29% reduction in recurrent stroke and TIA than those with LDL cholesterol >= 120 mg/dL (event rate 2.20 vs. 3.11 per 100 person-years, hazard ratio [HR] 0.71, 95% confidence interval (CI) 0.50-0.99, p = 0.048). Patients with CRP < 1 mg/L had 32% reduction compared with that of patients with CRP >= 1 mg/L (event rate 2.26 vs. 3.40 per 100 person-years; HR 0.68, 95% CI 0.48-0.96, p = 0.031). Although LDL cholesterol and CRP levels were not correlated in individual patients, those who achieved both LDL cholesterol < 120 mg/dL and CRP < 1 mg/L showed 51% reduction compared with that of patients with LDL cholesterol >= 120 mg/dL and CRP >= 1 mg/L (event rate 2.02 vs. 4.19 per 100 person-years; HR 0.49, 95% CI 0.31-0.79). Conclusions: The control of both LDL cholesterol and CRP levels appears to be effective for preventing recurrent stroke and TIA in patients with non-cardiogenic ischemic stroke.