More Than 50 Percent Reduction in LDL Cholesterol in Patients With Target LDL <70 mg/dL After a Stroke
Authors: Amarenco Pierre , Lavallée Philippa C. , Kim Jong S. , Labreuche Julien , Charles Hugo , Giroud Maurice , Lee Byung-Chul , Mahagne Marie-Hélène , Meseguer Elena , Nighoghossian Norbert , Steg Philippe Gabriel , Vicaut Éric , Bruckert Eric , Kim Jong S , Touboul Pierre-Jean , Leys Didier , Béjot Yannick , Pico Fernando , Touzé Emmanuel , Ducrocq Gregory , Abtan Jérémy , Varenne Olivier , Touboul Pierre-Jean , Kemmel Agnes , Syana Fausta , Ledra Manele , Nagasara Tharani , Ledjeroud Mervette , Samia Bahous , Hadia Hafirassou , Hazare Benyoub , Jaghouni Ikrame El , Yelles Nessima , Zemouri Sofia , Ladjeroud Mervette , Kerai Salim , In YunJeong , Hobeanu Cristina , Guidoux Celine , Cabrejo Lucie , Lapergue Bertrand , Sabben Candice , Gonzalez-Valcarcel Jaime , Rigual Ricardo , Sirimarco Gaia , Martin-Bechet Anna , Viedma Elena , Avram Ioan , Samson Yves , Rosso Charlotte , Crozier Sophie , Leder Sara , Léger Anne , Deltour Sandrine , Mutlu Gurkan , Yger Marion , Zavanone Chiara , Baronnet Flore , Pires Christine , Lapergue Bertrand , Wang Adrien , Evrard Serge , Tchikviladze Maya , Bourdain Frédéric , Lopez Delphine , Pico Fernando , de la Tour Laetitia Bayon , Chadenat Marie-Laure , Duong Duc Long , Genty Solène , Hirel Catherine , Mutlu Gurkan , Nifle Chantal , Servan Jérôme , Stanciu Daniela , Sudacevschi Veronica , Tir Mélissa , Troussière Anne-Cécile , Yeung Jennifer , Zeghoudi Anne-Céline , Tidafi-Bayou Ikram , Lachaud Sylvain , Cho Tae-Hee , Mechtouff Laura , Ritzenthaller Thomas , Derex Laurent , Albanesi Carlo , Ong Elodie , Benoit Amandine , Berhoune Nadia , Felix Sandra , Esteban-Mader Maud , Sibon Igor , Kazadi Annabelle , Rouanet François , Renou Pauline , Debruxelles Sabrina , Poli Mathilde , Sagnier Sharmila , Mas Jean-Louis , Domigo Valérie , Lamy Catherine , Bodiguel Eric , Grimaud Jérôme , Bohotin Valentin , Obadia Michael , Sabben Candice , Morvan Erwan , Rodier Gilles , Vadot Wilfried , Hénon Hilde , Cordonnier Charlotte , Dumont Frédéric , Bodenant Marie , Lucas Christian , Moulin Solène , Dequatre Nelly , Alamowitch Sonia , Muresan Jean-Paul , Drouet Thomas , Gallea Magalie , Dalloz Marie-Amélie , Delorme Stephen , Yger Marion , Béjot Yannick , Loisel Philippe , Bonnin Carine , Bernigal Virginie , Osseby Guy Victor , Hervieu-BègueMarsac Marie , Garnier Pierre , Accassat Sandrine , Epinat Magali , Varvat Jérôme , Marinescu Doïna , Triquenot-Bagan Aude , Ozkul- Wermester Ozlem , Philippeau Frédéric , Olaru Angel , Vieillart Anne , Lannuzel Annie , Demoly Alice , Wolff Valérie , Diaconu Mihaela , Bataillard Marc , Montoro Francisco Macian , Faugeras Frédéric , Gimenez Laeticia , Abdallah-Lebeau Françoise , Timsit Serge , Viakhireva-Dovganyuk Irina , Tirel-Badets Anne , Merrien François-Mathias , Goas Philippe , Rouhart François , Jourdain Aurore , Guillon Benoit , Hérissson Fanny , Sevin-Allouet Mathieu , Nasr Nathalie , Olivot Jean-Marc , Lecluse Alderic , Marc Guillaume , Touzé Emmanuel , de la Sayette Vincent , Apoil Marion , Lin Li , Cogez Julien , Guettier Sophie , Godefroy Olivier , Lamy Chantal , Bugnicourt Jean-Marc , Taurin Grégory , Mérienne Marc , Gere Julien , Chessak Anne-Marie , Habet Tarik , Ferrier Anna , Bourgois Nathalie , Minier Dominique , Caillier-Minier Marie , Contégal- Callier Fabienne , Vion Philippe , Vaschalde Yvan , Amrani Mohammed El , Emilie  , Zuber Mathieu , Bruandet Marie , Join- Lambert Claire , Garcia Pierre-Yves , Serre Isabelle , Faucheux Jean-Marc , Radji Fatia , Leca-Radu Elena , Debroucker Thomas , Cumurcuc Rodica , Cakmak Serkan , Peysson Stéphane , Ellie Emmanuel , Bernady Patricia , Moulin Thierry , Montiel Paola , Revenco Eugeniu , Decavel Pierre , Medeiros Elisabeth , Bouveret Myriam , Louchart Pierre , Vaduva Claudia , Couvreur Grégory , Sartori Eric , Carpentier Alnajar , Levasseur Michèle , Louchart Pierre , Faucheux Jean-Marc , Neau Philippe , Vandamme Xavier , Meresse Isabelle , Stantescu  , Bataillard Marc , Ozsancak Canan , Beauvais Katell , Auzou Pascal , Amevigbe Joséphine , Vuillemet Francis , Dugay-Arentz Marie-Hélène , Carelli Gabriela , Martinez Mikel , Maillet-Vioud Marcel , Escaillas Jean-Pierre , Chapuis Stéphane , Tardy Jean , Manchon Eric , Varnet Olivier , Kim Yong-Jae , Chang Yoonkyung , Song Tae-Jin , Kim Jong Sung , Han Jung-Hoon , Noh Kyung Chul , Lee Eun-Jae , Kang Dong-Wha , Kwon Sun Uck , Kwon Boseoung , Park Seongho , Lee Dongwhane , Kwon Hyuk Sung , Jeong Daeun , Lee MinHwan , Kim Joonggoo , Lee Hanbin , Nam Hyo Jung , Lee Sang Hun , Kim Bum Joon , Cha Jae-kwan , Kim DaeHyun , Kim Rae Young , Sohn Sang Wuk , Shim Dong-Hyun , Lee Hyungjin , Nah Hyun-Wook , Sung Sang Min , Lee Kyung Bok , Yoon Lee Jeong , Yoon Jee Eun , Kim Eung-Gyu , Seo Jung Hwa , Kim Yong-Won , Hwang Yangha , Park Man Seok , Kim Joon-Tae , Choi Kang-Ho , Nam Hyo Suk , Heo Ji Hoe , Kim Young Dae , Hwang In Gun , Park Hyung Jong , Kim Kyoung Sub , Baek Jang Hyun , Song Dong Beom , Yoo Joon Sang , Park Jong-Moo , Kwon Ohyun , Lee Woong-Woo , Lee Jung-Ju , Kang Kyusik , Kim Byung Kun , Lim Jae-Sung , Oh Mi Sun , Yu Kyung-Ho , Hong Bora , Jang Mihoon , Jang Seyoung , Jin Jung Eun , Kim Jei , Jeong Hye Seon , Hong Keun Sik , Park Hong Kyun , Cho Yong Jin , Bang Oh Young , Seo Woo-Keun , Chung Jongwon 
Published: June 2023

BACKGROUND:

Whether a strategy to target an LDL (low-density lipoprotein) cholesterol <70 mg/dL is more effective when LDL is reduced >50% from baseline rather than <50% from baseline has not been investigated.

METHODS:

The Treat Stroke to Target trial was conducted in France and South Korea in 61 sites between March 2010 and December 2018. Patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis were randomly assigned to a target LDL cholesterol of <70 mg/dL or 100±10 mg/dL, using statin and/or ezetimibe as needed. We used the results of repeated LDL measurements (median, 5 [2–6] per patient) during 3.9 years (interquartile range, 2.1–6.8) of follow-up. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death. Cox regression model including lipid-lowering therapy as a time-varying variable, after adjustment for randomization strategy, age, sex, index event (stroke or transient ischemic attack), and time since the index event.

RESULTS:

Among 2860 patients enrolled, patients in the lower target group who had >50% LDL cholesterol reduction from baseline during the trial had a higher baseline LDL cholesterol and a lower LDL cholesterol achieved as compared to patients who had <50% LDL cholesterol reduction (155±32 and 62 mg/dL versus 121±34 and 74 mg/dL, respectively,
P
<0.001 for both). In the <70 mg/dL target group, patients with >50% LDL reduction had a significant reduction in the primary outcome as compared to the higher target group (hazard ratio, 0.61 [95% CI, 0.43–0.88];
P
=0.007) and patients with <50% LDL reduction from baseline had little reduction (hazard ratio, 0.96 [95% CI, 0.73–1.26];
P
=0.75).

CONCLUSIONS:

In this post hoc analysis of the TST trial, targeting an LDL cholesterol of <70 mg/dL reduced the risk of primary outcome compared with 100±10 mg/dL provided LDL cholesterol reduction from baseline was superior to 50%, thereby suggesting that the magnitude of LDL cholesterol reduction was as important to consider as the target level to achieve.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01252875. URL:
https://clinicaltrialsregister.eu
; Unique identifier: EUDRACT2009-A01280-57.