Background and Aims: PCSK9 inhibitors effectively clear low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). Current trials are evaluating efficacy to reduce cardiovascular events. We evaluated stroke admissions potentially eligible for more intensive cholesterol treatment. Method: Retrospective analysis of consecutive admissions to the stroke unit over 5 months in 2017. Records were hand-searched. Data were collected on diagnosis, risk factors and stroke work-up. The Dutch Lipid Clinic Network Algorithm for Familial Hypercholesterolemia (FH) screening and TOAST classification were used. Results: We achieved 100% case record ascertainment of 650 patients admitted. 351(54%) had acute ischaemic stroke (AIS) or TIA, 80(12%) haemorrhage and 219(34%) mimic syndromes. Of 351 AIS/TIA patients, 27 had no LDL-C or non-HDL-C testing leaving 324 of whom: -6 had possible FH (LDL-C >5.0 mmol/l). -23 had LDL-C >4.0mmol/l, or 3.5-3.9mmol/l and concomitant very high vascular risk (>1 vascular bed involved). -21 had non-HDL-C >3.4mmol/l and recurrent cardiovascular events. (Evolocumab reduces elevated non-HDL-C which is associated with stroke). 50(15%) patients potentially eligible for PCSK9 inhibitors were identified: mean age 74yrs (±12), 40% hypertension, 34% ischaemic heart disease, 28% atrial fibrillation, 16% diabetes, 8% peripheral vascular disease. 28% had cardioembolic events, 16% lacunar syndrome, 8% symptomatic ICA stenosis >70% and 48% other undetermined aetiology. 50% had history of recurrent cerebrovascular events versus 31% in treatment non-eligible AIS/TIA cohort, p=0.007. Conclusion: Up to 15% of unselected acute ischaemic stroke or TIA patients were potentially suitable for more intensive cholesterol treatment. Our data may guide sample size selection for stroke trials testing these new drugs.
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