{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T08:05:38Z","timestamp":1782893138804,"version":"3.54.5"},"reference-count":26,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T00:00:00Z","timestamp":1678233600000},"content-version":"unspecified","delay-in-days":7,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Key R&D Program of China","award":["2018YFC1312903"],"award-info":[{"award-number":["2018YFC1312903"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81801139"],"award-info":[{"award-number":["81801139"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81870905"],"award-info":[{"award-number":["81870905"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82071295"],"award-info":[{"award-number":["82071295"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Beijing Hospitals Authority Innovation Studio of Young Staff Funding Support","award":["202113"],"award-info":[{"award-number":["202113"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Our study was a post hoc analysis of the Third China National Stroke Registry (CNSR-III).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>We derived data from the CNSR-III - a nationwide clinical registry of ischaemic stroke and TIA based on 201 participating hospitals in mainland China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>15,166 patients were included in this study with demographic characteristics, etiology, imaging, and biological markers from August 2015 to March 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary and secondary outcome measures<\/jats:title><jats:p>The primary outcome was a new stroke, LDL-C goal (LDL-C&lt;1.8mmol\/L and LDL-C&lt;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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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 \u22641.4mmol\/L had a numerically lower risk of stroke, ischemic stroke and MACE at both 3 months and 12 months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>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&lt;1.4mmol\/L might be a safe standard for this population.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-069465","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T14:13:13Z","timestamp":1678284793000},"page":"e069465","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Lipid management in ischaemic stroke or transient ischaemic attack in China: result from China National Stroke Registry III"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7109-1283","authenticated-orcid":false,"given":"Yu-Yuan","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2551-9314","authenticated-orcid":false,"given":"Wei-Qi","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng-Xing","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue-Song","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4713-5418","authenticated-orcid":false,"given":"Zi-Xiao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Ping","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing-Quan","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi-Long","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-Jun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Meng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,3,8]]},"reference":[{"key":"2023080102152656000_13.3.e069465.1","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2020-000457"},{"key":"2023080102152656000_13.3.e069465.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa061894"},{"key":"2023080102152656000_13.3.e069465.3","doi-asserted-by":"crossref","unstructured":"Amarenco P , Kim JS , Labreuche J , et al . A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med 2020;382:9. doi:10.1056\/NEJMoa1910355","DOI":"10.1056\/NEJMc2001195"},{"key":"2023080102152656000_13.3.e069465.4","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/2396987319841187","article-title":"Antithrombotic treatment for secondary prevention of stroke and other thromboembolic events in patients with stroke or transient ischemic attack and non-valvular atrial fibrillation: a European stroke organisation guideline","volume":"4","author":"Klijn","year":"2019","journal-title":"Eur Stroke J"},{"key":"2023080102152656000_13.3.e069465.5","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000375"},{"key":"2023080102152656000_13.3.e069465.6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1177\/2396987319838100","article-title":"Treat stroke to target trial design: first trial comparing two LDL targets in patients with atherothrombotic strokes","volume":"4","author":"Amarenco","year":"2019","journal-title":"Eur Stroke J"},{"key":"2023080102152656000_13.3.e069465.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)61088-0"},{"key":"2023080102152656000_13.3.e069465.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2006.00045.x"},{"key":"2023080102152656000_13.3.e069465.9","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1111\/ijs.12270","article-title":"Race-ethnicity and cerebral small vessel disease -- comparison between Chinese and white populations","volume":"9 Suppl A100","author":"Mok","year":"2014","journal-title":"Int J Stroke"},{"key":"2023080102152656000_13.3.e069465.10","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02530.x"},{"key":"2023080102152656000_13.3.e069465.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15690-0"},{"key":"2023080102152656000_13.3.e069465.12","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.jacc.2021.08.011","article-title":"Baseline low-density lipoprotein cholesterol and clinical outcomes of combining ezetimibe with statin therapy in Improve-IT","volume":"78","author":"Oyama","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2023080102152656000_13.3.e069465.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1615664"},{"key":"2023080102152656000_13.3.e069465.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.03.007"},{"key":"2023080102152656000_13.3.e069465.15","doi-asserted-by":"publisher","DOI":"10.1136\/svn-2019-000242"},{"key":"2023080102152656000_13.3.e069465.16","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.atherosclerosis.2018.08.040","article-title":"Optimising treatment of hyperlipidaemia: quantitative evaluation of UK, USA and european guidelines taking account of both LDL cholesterol levels and cardiovascular disease risk","volume":"278","author":"Soran","year":"2018","journal-title":"Atherosclerosis"},{"key":"2023080102152656000_13.3.e069465.17","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.atherosclerosis.2019.08.014","article-title":"2019 ESC\/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk","volume":"290","year":"2019","journal-title":"Atherosclerosis"},{"key":"2023080102152656000_13.3.e069465.18","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1016\/j.jacl.2018.06.011","article-title":"Twenty-year epidemiologic study on LDL-C levels in relation to the risks of atherosclerotic event, hemorrhagic stroke, and cancer death among young and middle-aged population in china","volume":"12","author":"Zhang","year":"2018","journal-title":"J Clin Lipidol"},{"key":"2023080102152656000_13.3.e069465.19","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.119.027759"},{"key":"2023080102152656000_13.3.e069465.20","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.001326"},{"key":"2023080102152656000_13.3.e069465.21","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1111\/cns.12543","article-title":"The management of LDL cholesterol and predictors of goal achievement in stroke patients in China: a cross-sectional study","volume":"22","author":"Wang","year":"2016","journal-title":"CNS Neurosci Ther"},{"key":"2023080102152656000_13.3.e069465.22","doi-asserted-by":"crossref","first-page":"199","DOI":"10.5551\/jat.40204","article-title":"Statin responses in Chinese patients","volume":"25","author":"Tomlinson","year":"2018","journal-title":"J Atheroscler Thromb"},{"key":"2023080102152656000_13.3.e069465.23","doi-asserted-by":"crossref","first-page":"485","DOI":"10.5551\/jat.50435","article-title":"Statin intolerance-an Asian perspective","volume":"27","author":"Tomlinson","year":"2020","journal-title":"J Atheroscler Thromb"},{"key":"2023080102152656000_13.3.e069465.24","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.121.034576"},{"key":"2023080102152656000_13.3.e069465.25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.37991.635266.44"},{"key":"2023080102152656000_13.3.e069465.26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.5853\/jos.2020.03391","article-title":"Residual risk and its risk factors for ischemic stroke with adherence to guideline-based secondary stroke prevention","volume":"23","author":"Pan","year":"2021","journal-title":"J Stroke"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-069465","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T09:19:26Z","timestamp":1690881566000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-069465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3]]},"references-count":26,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,3,8]]},"published-print":{"date-parts":[[2023,3]]}},"alternative-id":["10.1136\/bmjopen-2022-069465"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-069465","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3]]}}}