Lower LDL Cholesterol Cuts Stroke Risk by 25%

Lowering LDL Cholesterol Linked to 25% Lower Stroke Risk

Source: Medscape Medical News – AHA Scientific Sessions 2025 (November 11, 2025)

Keynotes:

1) Achieving LDL < 40 mg/dL in patients with prior ischemic stroke significantly reduces:
• 31% ↓ MACE
• 27% ↓ all strokes

• 25% ↓ ischemic stroke
• No increase in hemorrhagic stroke risk.

Study Details

• Data from 5291 patients (FOURIER + FOURIER-OLE).
• Follow-up: 7–8 years.
• Benefit increased stepwise as LDL decreased (“the lower, the better”). • Even <20 mg/dL showed no safety signal.

Clinical Meaning

• Extremely low LDL appears safe despite concerns about hemorrhagic stroke. • Supports aggressive LDL targets for stroke survivors.
• May influence AHA/ACC 2026 guideline update.

Background Context

• US guideline threshold: <70 mg/dL (AHA/ACC 2018).
• ESC/EAS 2019 recommends <55 mg/dL for very high-risk patients. • New analysis suggests <40 mg/dL may be ideal.

Expert Opinions

• “No floor effect — lower LDL consistently improves outcomes.” • External experts confirm strong safety and benefit data.

Conclusion

Very intensive LDL lowering (<40 mg/dL) in ischemic stroke patients: → reduces recurrent stroke & cardiovascular events
→ does not increase hemorrhagic stroke
→ likely practice-changing in 2026

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