Prevalence and determinants of low-density lipoprotein cholesterol goal attainment in Thai patients with ischemic stroke or transient ischemic attack

Optimal LDL-C control is essential to reduce the long-term burden of atherosclerotic complications. Attaining recommended low-density lipoprotein cholesterol (LDL-C) levels among individuals with ischemic stroke or transientischemic attack (TIA) is a key objective in secondary prevention of recurrent vascular events. This retrospective cohort analysis sought to determine the prevalence ofachieving LDL-C targets and to evaluate the association between determinants and LDL-C goal attainment following an acute ischemic cerebrovascular event. The study included Thai patients admitted with ischemic stroke or TIA who were prescribed statin therapy upon hospital discharge. Patient data were retrospectively extracted from the hospital electronic medical record system using standardized case record forms for the period between 2019 and 2022. LDL-C goal attainment was assessed at 12 months after discharge. Logistic regression was performed to identify clinical predictors associated with achieving LDL-C targets, while a generalized linear model (GLM) was used to estimate the influence of clinical covariates on the percentage reduction in LDL-C. A total of 487 patients, LDL-C goal attainment varied according to the applied thresholds: 70.4% for <100 mg/dL, 29.0% for <70 mg/dL, 9.9% for <55 mg/dL, and 17.5% for a ≥50% reduction from baseline. High-intensity statin therapy independently predicted LDL-C targets of <100 mg/dL (OR 1.64; 95% CI 1.01–2.67), <70 mg/dL (OR 1.91; 95% CI 1.09–3.34), and a ≥50% reduction (OR 2.32; 95% CI 1.14–4.73), while the association for <55 mg/dL was not statistically significant (OR 1.65; 95% CI 0.72–3.79). The GLM indicated that both statin intensity and baseline LDL-C levels significantly influenced the magnitude of LDL-C lowering. In summary, LDL-C target attainment in ischemic stroke and TIA patients remained suboptimal, particularly for the stringent threshold. High-intensity statin use emerged as a robust determinant of LDL-C lowering and goal attainment, reinforcing its importance in post-stroke lipid management. Strengthening clinician awareness, optimizing treatment adherence, and ensuring timely escalation of lipid-loweringtherapy are imperative to narrow therapeutic gaps and maximize long-term cardiovascular protection in this population.