The combination of higher serum oxidized low-density lipoprotein (oxLDL) and LDL levels was found to be associated with an increased risk for recurrent stroke and poor functional outcomes in patients who have had minor stroke or are at high risk for transient ischemic attacks (TIAs), according to a study published in Atherosclerosis.

The data of 3019 patients from the Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events trial (CHANCE; identifier: NCT00979589) were examined. Participants were divided according to their baseline levels of LDL (low: LDL <3.37 mmol/L; high LDL: ≥3.37 mmol/L) and oxLDL (low: oxLDL <13.96 μg/dL; high: oxLDL ≥13.96 μg/dL). Occurrence of stroke within 90 days was the study’s primary outcome; secondary outcomes included the occurrence of stroke within 1 year, and the occurrence of ischemic stroke and combined vascular events within 90 days and 1 year.

Patients with high vs low levels of LDL and oxLDL were found to be increased risk for recurrent stroke at 90 days (hazard ratio [HR], 1.57; 95% CI, 1.10-2.24) and 1 year (HR, 1.49; 95% CI, 1.10-2.04). The recurrence of stroke was comparable in patients with LDL ≥3.37 mmol/L and oxLDL <13.96 μg/dL (HR, 1.35; 95% CI, 0.94-1.93) and those with LDL <3.37 mmol/L and oxLDL ≥13.96 μg/dL (HR, 1.11; 95% CI, 0.77-1.59).

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Study limitations include the use of the oxLDL-4E6 antibody, which may cross-react with native LDL and relies on adequate lysine modifications on apoB-10013, insufficient data to assess the association between oxLDL/LDL and different stroke subtypes or carotid atherosclerosis, and the lack of evaluation of the dynamic changes in oxLDL and LDL at different stages of follow-up.

“In this subgroup analysis of the CHANCE trial, we found that joint elevation of both high LDL and oxLDL levels was associated with recurrent stroke, also in ischemic stroke and combined vascular events, in patients with minor stroke or TIA during the first 90 days and 1 year,” the researchers concluded. “Detection of circulating LDL with its oxidation may identify specific targets for future therapy, offering better focused and, potentially, personalized treatment of minor stroke.”


Wang A, Dai L, Zhang N, et al. Oxidized low-density lipoprotein (LDL) and LDL cholesterol are associated with outcomes of minor stroke and TIAAtherosclerosis. 2020;297:74-80.