What are the benefits of intensive lipid management for stroke prevention among patients with aortic plaques?
Prospective studies have found an increased stroke recurrence rate among patients with aortic plaques 4 mm in thickness, particularly with ulceration or mobile or without plaque calcifications. There is evidence that treating patients with ischemic stroke and evidence of atherosclerosis to an LDL target of <70 mg/dL is more effective in stroke prevention than less intensive lipid management. The ARCH study (Aortic Arch Related Cerebral Hazard Trial) showed event rates were only 20-30% of the 12% rate expected from observational studies, likely due to better risk factor management. Mean LDL-C was reduced by 40 mg/dL to 83-84 mg/dL, suggesting even lower event rates with current, more intensive recommendations for hypertension and cholesterol management.