geoffrey modest medical blogs

A new article from last week's Am Heart Assn meetings found that treating LDL to a lower target led to fewer subsequent cardiovasc events in those with TIA/ischemic stroke (see  stroke LDL target nejm2019  in dropbox, or DOI: 10.1056/NEJMoa1910355) Details: --2860 patients with evidence of atherosclerotic disease, having had ischemic stroke in prior 3 months or TIA in the previous 15 days, were randomized to a target LDL of <70 mg/dL vs 90-110mg/dL, using adjustable doses of statins with ezetimibe as needed, in  the Treat Stroke to Target trial  from France (61 sites) and South Korea (16 sites)     -- ischemic stroke was defined as symptoms with documented    ischemic lesion on CT or MRI; TIAs had to be a motor deficit in one arm or leg, or speech disturbance >10 minutes     --all patients were screened with nonivasive imaging (carotid duplex, CT angiography, and MR angiography) per the AHA-ASA...

A meta-analysis challenged the published statistic of the protective effect of aspirin after a TIA or ischemic stroke, showing that the effect of aspirin is much greater than believed, especially if given within days of the event (s ee  stroke TIA early ASA  rx  lancet2016  in  dropbox , or  doi.org/10.1016/S0140-6736(16)30468-8   ) . details: --background:     --risk of recurrent stroke is 10% in the week after a TIA or minor stroke     --but many patients delay seeking medical attention for days-to-weeks after these events     --in the UK, 1/2 of recurrent strokes happen prior to seeking medical attention     --pre-hospital use of self-administered aspirin is often discouraged for fear of exacerbating intracerebral bleed     --BUT, hemorrhage is a rare cause of TIAs and is in <5% of minor strokes    ...