The name of the article I chose was “Association Between Intensity of Low-Density Lipoprotein Cholesterol Reduction With Statin-Based Therapies and Secondary Stroke Prevention” by Meng Lee et al. The article was published in the JAMA neurology in Feb of 2022. This article was Meta-analysis of Randomized Clinical Trials that utilized 37 full articles for detailed assessment, out of those 26 did not meet the inclusion criteria; therefore, the final analysis was composed of 11 randomized clinical trials and 20 163 patients with stroke were enrolled. The mean duration of follow-up was 4 years. The final mean LDL-C level, weighted for trial size, was 79 mg/dL in the groups that received more intensive LDL-C lowering and 119 mg/dL in the groups that received less intensive LDL-C lowering. Among the 11 included trials, 6 compared statins vs no statins, 3 compared more statins or ezetimibe vs less statins or ezetimibe, and 2 compared PCSK9 inhibitors plus statins vs placebo plus statins. Among the 3 trials that compared more statins or ezetimibe vs less statins or ezetimibe, 1 compared ezetimibe plus simvastatin with placebo plus simvastatin, 1 compared intensive lipid lowering with statin-based therapies with guideline lipid lowering with statin-based therapies, and 1 compared lower-target, LDL-C level <70 mg/dL, with higher-target, LDL-C level, 90-110 mg/dL.

     In the Treat Stroke to Target trial, 99% of patients in the lower-target group vs 79% in the higher-target group received moderate- or high-intensity statins, and 41% of patients in the lower-target group vs 7% in the higher-target group received combined statins plus ezetimibe. The study concluded that more intensive LDL-C–lowering statin-based therapies were associated with a 12% reduced risk of recurrent stroke and a 17% reduced risk of MACE, as well as a 46% increased risk of hemorrhagic stroke, compared with less intensive LDL-C–lowering statin-based therapies. In addition, more intensive LDL-C–lowering statin-based therapies were associated with a reduced risk of recurrent myocardial infarction but were associated with a higher risk for new-onset diabetes, compared with less intensive LDL-C–lowering statin-based therapies. It was also found that there was no reduced risk of recurrent stroke among patients not having evidence of atherosclerosis. One limitation of the study was that the purpose of several of the included trials was not to primarily evaluate more intensive vs less intensive LDL-C–lowering statin-based therapies for patients with ischemic stroke. Also, in some of the studies the characteristics of the index stroke and the duration between the index stroke and the trial initiation were usually vague. The sample sizes among the trials varied. Sample sizes were fewer than 200 patients in 3 studies and between 200 and 1000 patients in another 3 studies. In conclusion, LDL-C–lowering statin-based therapies are indicated for patients with ischemic stroke and an LDL-C level of higher than 100 mg/dL, high-intensity statins, such as atorvastatin, 80 mg daily, should probably be used only when there is evidence of atherosclerosis.