Benefit of Targeting a LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL During 5 Years After Ischemic Stroke
Authors: Amarenco Pierre , Kim Jong S. , Labreuche Julien , Charles Hugo , Giroud Maurice , Lee Byung-Chul , Mahagne Marie-Hélène , Nighoghossian Norbert , Gabriel Steg Philippe , Vicaut Éric , Bruckert Eric , Touboul Pierre-Jean , Leys Didier , Béjot Yannick , Lavallée Philippa , 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 , El Jaghouni Ikrame , Yelles Nessima , Zemouri Sofia , Ladjeroud Mervette , Kerai Salim , In Yun Jeong , Meseguer Elena , Lavallée Philippa C , 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 , Marsac Marie Hervieu-Bègue , 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 , El Amrani, Emilie Mohammed , 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 , Alnajar-Carpentier Eric , Levasseur Michèle , Louchart Pierre , Neau Jean-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 , 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 , Young Kim Rae , Sohn Sang Wuk , Shim Dong-Hyun , Lee Hyungjin , Nah Hyun-Wook , Sung Sang Min , Lee Kyung Bok , Lee Jeong Yoon , 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: March 2020

Background and Purpose—

The TST trial (Treat Stroke to Target) evaluated the benefit of targeting a LDL (low-density lipoprotein) cholesterol of <70 mg/dL to reduce the risk of cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature or aortic arch plaque >4 mm, in a French and Korean population. The follow-up lasted a median of 5.3 years in French patients (similar to the median follow-up time in the SPARCL trial [Stroke Prevention by Aggressive Reduction in Cholesterol Level]) and 2.0 years in Korean patients. Exposure duration to statin is a well-known driver for cardiovascular risk reduction. We report here the TST results in the French cohort.

Methods—

One thousand seventy-three French patients were assigned to <70 mg/dL (1.8 mmol/L) and 1075 to 100±10 mg/dL (90–110 mg/dL, 2.3–2.8 mmol/L). To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe on top if needed. The primary outcome was the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization and vascular death.

Results—

After a median follow-up of 5.3 years, the achieved LDL cholesterol was 66 (1.69 mmol/L) and 96 mg/dL (2.46 mmol/L) on average, respectively. The primary end point occurred in 9.6% and 12.9% of patients, respectively (HR, 0.74 [95% CI, 0.57–0.94];
P
=0.019). Cerebral infarction or urgent carotid revascularization following transient ischemic attack was reduced by 27% (
P
=0.046). Cerebral infarction or intracranial hemorrhage was reduced by 28% (
P
=0.023). The primary outcome or intracranial hemorrhage was reduced by 25% (
P
=0.021). Intracranial hemorrhages occurred in 13 and 11 patients, respectively (HR, 1.17 [95% CI, 0.53–2.62];
P
=0.70).

Conclusions—

After an ischemic stroke of documented atherosclerotic origin, targeting a LDL cholesterol of <70 mg/dL during 5.3 years avoided 1 subsequent major vascular event in 4 (number needed to treat of 30) and no increase in intracranial hemorrhage.

Registration—

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT01252875.