Journal of Stroke and Cerebrovascular Diseases · Oct 28, 2026

Associations of early measured low-density lipoprotein cholesterol with 12-month stroke recurrence and 90-day functional outcome after moderate-to-severe ischemic stroke

By Chen M, Zhu Y, Li H et al.

BACKGROUND AND PURPOSE: Current secondary prevention guidelines generally target low-density lipoprotein cholesterol (LDL-C) <1.8 mmol/L after ischemic stroke, but the prognostic relevance of an early level <1.4 mmol/L remains unclear. We examined associations of LDL-C measured within 15 days with 12-month recurrent ischemic stroke and 90-day functional outcomes in patients with moderate-to-severe acute ischemic stroke (AIS). METHODS: This retrospective day-15 landmark cohort included 1,800 adults with admission National Institutes of Health Stroke Scale scores of 6-20. All were alive and recurrence-free at day 15. The last fasting LDL-C within 15 days defined groups of <1.4, 1.4-1.8, or >1.8 mmol/L. Cox and Fine-Gray models assessed recurrence. A partial proportional odds model assessed the 90-day modified Rankin Scale (mRS). RESULTS: Recurrent ischemic stroke occurred in 213 patients (11.8%). Recurrence proportions were 6.7%, 9.9%, and 14.2% across groups (global P=0.014). Compared with >1.8 mmol/L, <1.4 mmol/L was associated with a lower recurrence hazard (adjusted hazard ratio 0.49, 95% confidence interval 0.28-0.83). Among 1,677 patients with mRS data, the pairwise common odds ratio (OR) was 1.38 (1.04-1.83), while the overall three-group P value was 0.056. Further adjustment for treatment and measurement day yielded a common OR of 1.37 (0.97-1.93). The day-121 analysis showed no clear association with later recurrence. CONCLUSIONS: Lower early LDL-C was associated with a lower subsequent recurrence hazard among patients meeting the day-15 landmark criteria. Functional findings remained exploratory.

doi.org/10.1016/j.jstrokecerebrovasdis.2026.108777Open accessPubMed 42950994Biomarkers