Achievement of Very Low Low-Density Lipoprotein Cholesterol Levels: Is It Time to Unlearn Concern for Hemorrhagic Stroke?

Data from Mendelian randomization studies suggest that for every ~1 mmol/L (~40 mg/dL) genetically elevated LDL-C level, there is a 12% increased relative risk in ischemic stroke driven by a 28% increased relative risk in ischemic strokes from large artery atherosclerosis.[5] In Asian societies, blood cholesterol levels tend to be lower than in Western societies, and although ischemic stroke is more common, hemorrhagic strokes make up a larger proportion of total strokes than in Western societies.[14] If the hypothesis is that low LDL-C level increases hemorrhage stroke risk, then one would expect the signal to become stronger in PCSK9 inhibitor trials, where the LDL-C has been driven lower than in prior statin trials. [Extracted from the article]