BMJ Open (Mar 2023)

Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III

  • ,
  • Xu Zhang,
  • Yongjun Wang,
  • Kangning Chen,
  • Lianbo Gao,
  • Ye Tian,
  • Xu Chen,
  • Yi Guo,
  • Benyan Luo,
  • Yan Wang,
  • Jian Wu,
  • Xiaohong Li,
  • Yong-Jun Wang,
  • Qiang Dong,
  • Huisheng Chen,
  • Wei Wang,
  • Zhengqi Lu,
  • Lijie Ren,
  • Runqing Wang,
  • Juan Feng,
  • Zhangyong Xia,
  • Hao Li,
  • Lihua Wang,
  • Qingwei Zhao,
  • Hong Wang,
  • Ting Wang,
  • Jin Zhou,
  • Xia Meng,
  • Jun Wu,
  • Qing Li,
  • Shizheng Wu,
  • Ping Zhang,
  • Li-Ping Liu,
  • Yue-song Pan,
  • Yi-long Wang,
  • Ming Yu,
  • Guohua Chen,
  • Zhimin Wang,
  • Jianhua Li,
  • Yi Wang,
  • Yi Yang,
  • Xinsheng Han,
  • Songdi Wu,
  • Yongming Chen,
  • Liang Zhao,
  • Qiang Ma,
  • Xiaoying Zhang,
  • Mei Zhang,
  • Limin Wang,
  • Hui Liang,
  • Liping Wang,
  • Jun Zhou,
  • Jie Lin,
  • Yu Geng,
  • Ning Wang,
  • Yun Xu,
  • Jinsheng Zeng,
  • Huijuan Wang,
  • Xueli Cai,
  • Jia Yin,
  • Jun Xu,
  • Feng Qiu,
  • Jun Zhao,
  • Baojun Wang,
  • Hainan Zhang,
  • Zi-Xiao Li,
  • Xing-Quan Zhao,
  • Mingzhi Zhao,
  • Yingchun Wu,
  • Junling Zhang,
  • Xuerong Qiu,
  • Zhongping An,
  • Wenjun Xue,
  • Lili Zhao,
  • Hongyan Li,
  • Junfeng Shi,
  • Tao Gong,
  • Qi Fang,
  • Liyan Liu,
  • Jianfeng Wang,
  • Guang Huang,
  • Chun Wang,
  • Yuwu Zhao,
  • Lei Sheng,
  • Lei Xia,
  • Yan Fang,
  • Xiaoxiang Peng,
  • Yanling Wang,
  • Yangmei Chen,
  • Deqin Geng,
  • Jinfeng Liu,
  • Weirong Li,
  • Yuqing Wei,
  • Yu-Yuan Xu,
  • Jilai Li,
  • Maolin He,
  • Quping Ouyang,
  • Fengchun Yu,
  • Chenlong Wang,
  • Jinli Zhang,
  • Wenqing Wu,
  • Yaoyu Yu,
  • Meiyun Zhang,
  • Junyan Liu,
  • Wanying Shi,
  • Baoquan Lu,
  • Lijun Geng,
  • Shujuan Wang,
  • Ruifang Liu,
  • Fengli Zhao,
  • Xinping Liu,
  • Xuebing Sun,
  • Tianyuan Li,
  • Youming Wang,
  • Xinxia He,
  • Weiqiang Yuan,
  • Ronghua Dou,
  • Lihai Liu,
  • Haisong Du,
  • Cunrui Wang,
  • Xiaofei Chen,
  • Fengyun Hu,
  • Fanping He,
  • Xingchen Wang,
  • Hongjin Li,
  • Mingzong Yan,
  • Guiru Zhang,
  • Yunlin Liu,
  • Yuhui Han,
  • Xianghong Meng,
  • Hongtian Zhang,
  • Congmin Ma,
  • Gexia Liu,
  • Wenxu Zheng,
  • Haitao Chi,
  • Hongbo Xiao,
  • Lijun Xiao,
  • Guozhong Li,
  • Yulan Zhu,
  • Yindong Yang,
  • Xuhai Gong,
  • Qunhui Liu,
  • Shiping Gong,
  • Hongbin Zhou,
  • Haipeng Li,
  • Yong You,
  • Jinsheng Lin,
  • Heqing Zhao,
  • Aixia Zhuang,
  • Kaifu Ke,
  • Zhengxie Dong,
  • Guiyun Cui,
  • Liangqun Rong,
  • Yi Wu,
  • Weiguo Tang,
  • Yanjiang Wang,
  • Wenguang Bu,
  • Xiaohua Cheng,
  • Jifu Cai,
  • Lvli Li,
  • Jianping Niu,
  • Liping Zhan,
  • Runxiu Zhu,
  • Yanhui Du,
  • Yongxia Wen,
  • Yongcai Qu,
  • Yuncheng Wu,
  • Jianren Liu,
  • Qingke Bai,
  • Chaoming He,
  • Weiwen Qiu,
  • Shufang Yao,
  • Xuwen Sun,
  • Ligong Gao,
  • Xianglin Chen,
  • Qiuyan Shi,
  • Zhaochen Li,
  • Tianbao Chen,
  • SuYun Yang,
  • Yazhou Han,
  • Xinxiao Wu,
  • Beihai Jiang,
  • Lizhong Li,
  • Weidong Lou,
  • Weiming Lan,
  • Aihu Zheng,
  • Qifu Bai,
  • Lifang Luan,
  • Liqing Yan,
  • Yanxia Wang,
  • Xuerong Huang,
  • Xiangting Chai,
  • Yanshu Liu,
  • Liangjun You,
  • Hongqin Yang,
  • Dongfang Li,
  • Linying Gui,
  • Aisheng Wu,
  • Dengling Wang,
  • Qinghua Zhang,
  • Yunhong He,
  • Ruiyou Guo,
  • Jijun Teng,
  • Ping Lou,
  • Wei-Qi Chen,
  • Meng-Xing Wang,
  • Yu’an Zou,
  • An’ding Xu,
  • Yinzhou Wang Li Pan,
  • Li’e Wu,
  • Yanru Zhao Li Liu,
  • Xiaoqian Shen

DOI
https://doi.org/10.1136/bmjopen-2022-069465
Journal volume & issue
Vol. 13, no. 3

Abstract

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Objectives The aims of the study were to assess the management of low-density lipoprotein cholesterol (LDL-C) and the goal achievement, as well as to investigate the association between baseline LDL-C level, lipid-lowering treatment (LLT), and stroke recurrence in patients with ischaemic stroke or transient ischaemic attack (TIA).Design Our study was a post hoc analysis of the Third China National Stroke Registry (CNSR-III).Setting We derived data from the CNSR-III - a nationwide clinical registry of ischaemic stroke and TIA based on 201 participating hospitals in mainland China.Participants 15,166 patients were included in this study with demographic characteristics, etiology, imaging, and biological markers from August 2015 to March 2018.Primary and secondary outcome measures The primary outcome was a new stroke, LDL-C goal (LDL-C<1.8mmol/L and LDL-C<1.4mmol/L, respectively) achievement rates, and LLT compliance within 3, 6, and 12 months. The secondary outcomes included major adverse cardiovascular events (MACE) and all caused death at 3 and 12 months.Results Among the 15,166 patients, over 90% of patients received LLT during hospitalization and 2 weeks after discharge; the LLT compliance was 84.5% at 3 months, 75.6% at 6 months, and 64.8% at 12 months. At 12 months, LDL-C goal achievement rate for 1.8mmol/L and 1.4mmol/L was 35.4% and 17.6%, respectively. LLT at discharge was associated with reduced risk of ischemic stroke recurrence (HR=0.69, 95% CI: 0.48-0.99, p=0.04) at 3 months. The rate of LDL-C reduction from baseline to 3-month follow-up was not associated with a reduced risk of stroke recurrence or major adverse cardiovascular events (MACE) at 12 months. Patients with baseline LDL-C ≤1.4mmol/L had a numerically lower risk of stroke, ischemic stroke and MACE at both 3 months and 12 months.Conclusions The LDL-C goal achievement rate has increased mildly in the stroke and TIA population in mainland China. Lowered baseline LDL-C level was significantly associated with a decreased short- and long-term risk of ischemic stroke among stroke and TIA patients. LDL-C<1.4mmol/L might be a safe standard for this population.