Abstract Body: Background and aims
Lipid-lowering therapy constitutes a cornerstone of secondary prevention in ischemic stroke; however, current stroke guidelines remain deficient in providing optimal target low-density lipoprotein (LDL)-cholesterol levels tailored to the stroke subtypes. Most clinical trials on LDL-cholesterol management have not differentiated between stroke subtypes or have primarily focused on large artery atherosclerosis (LAA) stroke, leaving a gap in evidence for managing LDL-cholesterol in other stroke subtypes, e.g., small vessel occlusion (SVO) stroke. While hypertension is the leading risk factor for SVO strokes, the link between elevated LDL-cholesterol and SVO stroke is also recognized. Establishing optimal LDL-cholesterol targets for SVO stroke would significantly enhance secondary prevention strategies and improve patient outcome. Thus, we aim to compare intensive versus standard lipid-lowering in patients with SVO stroke.

Methods
SVO70 is a multicenter, prospective, randomized, open, blinded-endpoint clinical trial. Adult patients with objectively confirmed SVO stroke within 180 days of randomization will be included. Exclusion criteria include those with predefined LDL-cholesterol targets for other conditions, statin contraindications, or women who are pregnant, breastfeeding, or planning pregnancy during the study period. Eligible participants will be randomized 1:1 to target LDL-cholesterol <70 mg/dL (intensive group) or 90-110 mg/dL (standard group). The trial plans to enroll 4,016 patients, with the primary outcome being major adverse cardiovascular events—cardiovascular death, stroke, and acute coronary syndrome—during a follow-up period of at least 4 years.

Status
The protocol of this study has been approved by the local institutional review board. The first participant was enrolled on October 4, 2024. The SVO70 trial is registered on ClinicalTrials.gov under the identifier NCT06649240.

Conclusions
This study would provide valuable information for determining the optimal LDL-cholesterol target for patients with SVO stroke.

Funding
This study is funded by Hanmi Pharmaceutical., which has no role in the study design, data collection, analysis, or interpretation.