Benefit of Targeting a LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL During 5 Years After Ischemic Stroke

作者：P. Amarenco, Jong S. Kim, J. Labreuche, Hugo Charles, M. Giroud, Byung‐Chul Lee, M. Mahagne, N. Nighoghossian, P. Gabriel Steg, E. Vicaut, E. Bruckert, P. Touboul, D. Leys, Y. Béjot, Philippa C. Lavallée, F. Pico, E. Touzé, G. Ducrocq, J. Abtan, O. Varenne, A. Kemmel, Fausta Syana, Manele Ledra, Tharani Nagasara, Mervette Ledjeroud, B. Samia, Hafirassou Hadia, Benyoub Hazare, Ikrame El Jaghouni, Nessima Yelles, Sofiane Zemouri, Mervette Ladjeroud, S. Kerai, Yunjeong In, E. Meseguer, Philippa C. Lavallée, Cristina Hobeanu, C. Guidoux, L. Cabrejo, B. Lapergue, C. Sabben, J. González-Valcárcel, R. Rigual, G. Sirimarco, Anna Martin-Bechet, Elena Viedma, Ioan Avram, Y. Samson, C. Rosso, S. Crozier, S. Leder, A. Leger, S. Deltour, G. Mutlu, M. Yger, C. Zavanone, F. Baronnet, C. Pires, Adrien Wang, S. Evrard, M. Tchikviladzé, F. Bourdain, D. Lopez, Laetitia Bayon de la Tour, M. Chadenat, D. Duong, S. Genty, C. Hirel, C. Nifle, J. Servan, D. Stanciu, V. Sudacevschi, M. Tir, A. Troussière, J. Yeung, A. Zeghoudi, Ikram Tidafi-Bayou, S. Lachaud, Tae-Hee Cho, L. Mechtouff, Thomas Ritzenthaller, L. Derex, Carlo Albanesi, Elodie Ong, Amandine Benoit, N. Berhoune, S. Felix, Maud Esteban-Mader, I. Sibon, A. Kazadi, F. Rouanet, P. Renou, S. Debruxelles, M. Poli, S. Sagnier, J. Mas, V. Domigo, C. Lamy, E. Bodiguel, J. Grimaud, V. Bohotin, M. Obadia, E. Morvan, G. Rodier, W. Vadot, H. Hénon, C. Cordonnier, F. Dumont, M. Bodenant, C. Lucas, S. Moulin, N. Dequatre, S. Alamowitch, J. Muresan, T. Drouet, Magalie Gallea, M. Dalloz, S. Delorme, P. Loisel, C. Bonnin, Virginie Bernigal, G. Osseby, M. Marsac, P. Garnier, S. Accassat, M. Epinat, J. Varvat, D. Marinescu, A. Triquenot-Bagan, O. Ozkul-Wermester, F. Philippeau, A. Olaru, A. Vieillart, A. Lannuzel, A. Demoly, V. Wolff, M. Diaconu, M. Bataillard, F. M. Montoro, F. Faugeras, Laeticia Gimenez, F. Abdallah-Lebeau, S. Timsit, I. Viakhireva-Dovganyuk, A. Tirel-Badets, François-Mathias Merrien, P. Goas, F. Rouhart, A. Jourdain, B. Guillon, Fanny Hérissson, M. Sévin-Allouet, N. Nasr, J. Olivot, A. Lécluse, G. Marc, Vincent de la Sayette, M. Apoil, Li Lin, J. Cogez, S. Guettier, O. Godefroy, C. Lamy, J. Bugnicourt, G. Taurin, M. Mérienne, J. Gere, Anne-Marie Chessak, T. Habet, A. Ferrier, N. Bourgois, D. Minier, M. Caillier-Minier, Fabienne Contégal-Callier, P. Vion, Y. Vaschalde, Mohammed El Amrani, Emilie, M. Zuber, M. Bruandet, Claire Join-Lambert, Pierre‐Yves Garcia, I. Serre, J. Faucheux, Fatia Radji, Elena Leca-Radu, T. Debroucker, Rodica Cumurcuc, S. Cakmak, S. Peysson, E. Ellie, P. Bernady, T. Moulin, P. Montiel, E. Revenco, P. Decavel, E. Medeiros, M. Bouveret, P. Louchart, C. Vaduva, G. Couvreur, É. Sartori, Eric Alnajar-Carpentier, M. Levasseur, J. Neau, X. Vandamme, Isabelle Méresse, Stantescu, C. Ozsancak, K. Beauvais, P. Auzou, Joséphine Amevigbe, F. Vuillemet, Marie-Hélène Dugay-Arentz, G. Carelli, Mikel J. Martínez, M. Maillet-Vioud, J. Escaillas, S. Chapuis, J. Tardy, E. Manchon, O. Varnet, Yong-Jae Kim, Yoonkyung Chang, Tae-Jin Song, J. Han, K. Noh, Eun-Jae Lee, D. Kang, S. Kwon, B. Kwon, Seongho Park, Dongwhane Lee, H. Kwon, Daeun Jeong, Min-Hwan Lee, J. Kim, Hanbin Lee, H. Nam, Sang Hun Lee, Bum Joon Kim, J. Cha, Daehyun Kim, Rae Young Kim, S. Sohn, D. Shim, Hyungjin Lee, H. Nah, S. Sung, K. Lee, Jeong Yoon Lee, Jee-Eun Yoon, Eung-Gyu Kim, J. Seo, Yong-Won Kim, Y. Hwang, Man-Seok Park, J. Kim, K. Choi, H. Nam, J. Heo, Y. Kim, I. G. Hwang, Hyungjong Park, Kyoung Sub Kim, Jang-Hyun Baek, D. Song, J. Yoo, Jong-Moo Park, O. Kwon, Woong-Woo Lee, Jung-Ju Lee, K. Kang, B. Kim, Jae-Sung Lim, M. Oh, K. Yu, Bo-Kyong Hong, Mi-Ra Jang, Seyoung Jang, Jung-Eun Jin, Jei Kim, H. Jeong, K. Hong, Hong‐Kyun Park, Yong‐Jin Cho, O. Bang, W. Seo, Jong-Won Chung · 发表于：Stroke · 年份：2020 · DOI：10.1161/STROKEAHA.119.028718 · 被引用次数：45 · 研究领域：Medicine

Supplemental Digital Content is available in the text. 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 urge...