Vasoproject

This parallel-group trial conducted in France and South Korea, randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both.
The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes.
In conclusion, after an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter (Treat Stroke to Target ClinicalTrial, TST trial).

1. Patients with premature cardiovascular disease or stroke without evident risk factors should have lipoprotein (a) levels measured at least once.
2. Patients with intermediate cardiovascular disease risk based on risk scores should be tested for lipoprotein (a), and if the level is higher than 50 mg/dL, the patient would be shifted to a higher risk category.
3. Patients with recurrent or rapidly progressive vascular disease and various recognized risk factors should have lipoprotein (a) levels checked and repeatedly monitored if on drug treatment.
4. Patients with familial hypercholesterolemia, genetic dyslipidemia or low HDL-C, or genetic defects of hemostasis or homocysteine metabolism should be tested for lipoprotein (a).
5. Patients without evident cardiovascular disease but elevated cardiovascular disease risk, such as a greater than 10% 10-year risk of fatal or nonfatal coronary heart disease as per the risk calculator should also be tested for lipoprotein (a)