Abstract
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.
| Original language | English |
|---|---|
| Pages (from-to) | 1231-1239 |
| Number of pages | 9 |
| Journal | Stroke |
| DOIs | |
| State | Accepted/In press - 2020 |
Keywords
- angiography
- aorta
- cholesterol, LDL
- informed consent
- stroke
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Benefit of Targeting a LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL during 5 Years after Ischemic Stroke. / Amarenco, Pierre; Kim, Jong S.; Labreuche, Julien et al.
In: Stroke, 2020, p. 1231-1239.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Benefit of Targeting a LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL during 5 Years after Ischemic Stroke
AU - Amarenco, Pierre
AU - Kim, Jong S.
AU - Labreuche, Julien
AU - Charles, Hugo
AU - Giroud, Maurice
AU - Lee, Byung Chul
AU - Mahagne, Marie Hélène
AU - Nighoghossian, Norbert
AU - Gabriel Steg, Philippe
AU - Vicaut, Éric
AU - Bruckert, Eric
AU - Touboul, Pierre Jean
AU - Leys, Didier
AU - Béjot, Yannick
AU - Lavallée, Philippa
AU - Pico, Fernando
AU - Touzé, Emmanuel
AU - Ducrocq, Gregory
AU - Abtan, Jérémy
AU - Varenne, Olivier
AU - Kemmel, Agnes
AU - Syana, Fausta
AU - Ledra, Manele
AU - Nagasara, Tharani
AU - Ledjeroud, Mervette
AU - Samia, Bahous
AU - Hadia, Hafirassou
AU - Hazare, Benyoub
AU - El Jaghouni, Ikrame
AU - Yelles, Nessima
AU - Zemouri, Sofia
AU - Ladjeroud, Mervette
AU - Kerai, Salim
AU - In, Yun Jeong
AU - Meseguer, Elena
AU - Lavallée, Philippa C.
AU - Hobeanu, Cristina
AU - Guidoux, Celine
AU - Cabrejo, Lucie
AU - Lapergue, Bertrand
AU - Gonzalez-Valcarcel, Jaime
AU - Rigual, Ricardo
AU - Sirimarco, Gaia
AU - Martin-Bechet, Anna
AU - Viedma, Elena
AU - Avram, Ioan
AU - Samson, Yves
AU - Rosso, Charlotte
AU - Crozier, Sophie
AU - Leder, Sara
AU - Léger, Anne
AU - Deltour, Sandrine
AU - Mutlu, Gurkan
AU - Yger, Marion
AU - Zavanone, Chiara
AU - Baronnet, Flore
AU - Pires, Christine
AU - Wang, Adrien
AU - Evrard, Serge
AU - Tchikviladze, Maya
AU - Bourdain, Frédéric
AU - Lopez, Delphine
AU - De La Tour, Laetitia Bayon
AU - Chadenat, Marie Laure
AU - Duong, Duc Long
AU - Genty, Solène
AU - Hirel, Catherine
AU - Nifle, Chantal
AU - Servan, Jérôme
AU - Stanciu, Daniela
AU - Sudacevschi, Veronica
AU - Tir, Mélissa
AU - Troussière, Anne Cécile
AU - Yeung, Jennifer
AU - Zeghoudi, Anne Céline
AU - Tidafi-Bayou, Ikram
AU - Lachaud, Sylvain
AU - Cho, Tae Hee
AU - Mechtouff, Laura
AU - Ritzenthaller, Thomas
AU - Derex, Laurent
AU - Albanesi, Carlo
AU - Ong, Elodie
AU - Benoit, Amandine
AU - Berhoune, Nadia
AU - Felix, Sandra
AU - Esteban-Mader, Maud
AU - Sibon, Igor
AU - Kazadi, Annabelle
AU - Rouanet, François
AU - Renou, Pauline
AU - Debruxelles, Sabrina
AU - Poli, Mathilde
AU - Sagnier, Sharmila
AU - Mas, Jean Louis
AU - Domigo, Valérie
AU - Lamy, Catherine
AU - Bodiguel, Eric
AU - Grimaud, Jérôme
AU - Bohotin, Valentin
AU - Obadia, Michael
AU - Sabben, Candice
AU - Morvan, Erwan
AU - Rodier, Gilles
AU - Vadot, Wilfried
AU - Hénon, Hilde
AU - Cordonnier, Charlotte
AU - Dumont, Frédéric
AU - Bodenant, Marie
AU - Lucas, Christian
AU - Moulin, Solène
AU - Dequatre, Nelly
AU - Alamowitch, Sonia
AU - Muresan, Jean Paul
AU - Drouet, Thomas
AU - Gallea, Magalie
AU - Dalloz, Marie Amélie
AU - Delorme, Stephen
AU - Loisel, Philippe
AU - Bonnin, Carine
AU - Bernigal, Virginie
AU - Osseby, Guy Victor
AU - Marsac, Marie Hervieu Bègue
AU - Garnier, Pierre
AU - Accassat, Sandrine
AU - Epinat, Magali
AU - Varvat, Jérôme
AU - Marinescu, Doïna
AU - Triquenot-Bagan, Aude
AU - Ozkul-Wermester, Ozlem
AU - Philippeau, Frédéric
AU - Olaru, Angel
AU - Vieillart, Anne
AU - Lannuzel, Annie
AU - Demoly, Alice
AU - Wolff, Valérie
AU - Diaconu, Mihaela
AU - Montoro, Francisco Mac Ian
AU - Faugeras, Frédéric
AU - Gimenez, Laeticia
AU - Abdallah-Lebeau, Françoise
AU - Timsit, Serge
AU - Viakhireva-Dovganyuk, Irina
AU - Tirel-Badets, Anne
AU - Merrien, François Mathias
AU - Goas, Philippe
AU - Rouhart, François
AU - Jourdain, Aurore
AU - Guillon, Benoit
AU - Hérissson, Fanny
AU - Sevin-Allouet, Mathieu
AU - Nasr, Nathalie
AU - Olivot, Jean Marc
AU - Lecluse, Alderic
AU - Marc, Guillaume
AU - De La Sayette, Vincent
AU - Apoil, Marion
AU - Lin, Li
AU - Cogez, Julien
AU - Guettier, Sophie
AU - Godefroy, Olivier
AU - Lamy, Chantal
AU - Bugnicourt, Jean Marc
AU - Taurin, Grégory
AU - Mérienne, Marc
AU - Gere, Julien
AU - Chessak, Anne Marie
AU - Habet, Tarik
AU - Ferrier, Anna
AU - Bourgois, Nathalie
AU - Minier, Dominique
AU - Caillier-Minier, Marie
AU - Contégal-Callier, Fabienne
AU - Vion, Philippe
AU - Vaschalde, Yvan
AU - El Amrani Emilie, Mohammed
AU - Zuber, Mathieu
AU - Bruandet, Marie
AU - Join-Lambert, Claire
AU - Garcia, Pierre Yves
AU - Serre, Isabelle
AU - Faucheux, Jean Marc
AU - Radji, Fatia
AU - Leca-Radu, Elena
AU - Debroucker, Thomas
AU - Cumurcuc, Rodica
AU - Cakmak, Serkan
AU - Peysson, Stéphane
AU - Ellie, Emmanuel
AU - Bernady, Patricia
AU - Moulin, Thierry
AU - Montiel, Paola
AU - Revenco, Eugeniu
AU - Decavel, Pierre
AU - Medeiros, Elisabeth
AU - Bouveret, Myriam
AU - Vaduva, Claudia
AU - Couvreur, Grégory
AU - Sartori, Eric
AU - Alnajar-Carpentier, Eric
AU - Levasseur, Michèle
AU - Louchart, Pierre
AU - Neau, Jean Philippe
AU - Vandamme, Xavier
AU - Meresse, Isabelle
AU - Stantescu,
AU - Bataillard, Marc
AU - Ozsancak, Canan
AU - Beauvais, Katell
AU - Auzou, Pascal
AU - Amevigbe, Joséphine
AU - Vuillemet, Francis
AU - Dugay-Arentz, Marie Hélène
AU - Carelli, Gabriela
AU - Martinez, Mikel
AU - Maillet-Vioud, Marcel
AU - Escaillas, Jean Pierre
AU - Chapuis, Stéphane
AU - Tardy, Jean
AU - Manchon, Eric
AU - Varnet, Olivier
AU - Kim, Yong Jae
AU - Chang, Yoonkyung
AU - Song, Tae Jin
AU - Han, Jung Hoon
AU - Noh, Kyung Chul
AU - Lee, Eun Jae
AU - Kang, Dong Wha
AU - Kwon, Sun Uck
AU - Kwon, Boseoung
AU - Park, Seongho
AU - Lee, Dongwhane
AU - Kwon, Hyuk Sung
AU - Jeong, Daeun
AU - Lee, Min Hwan
AU - Kim, Joonggoo
AU - Lee, Hanbin
AU - Nam, Hyo Jung
AU - Lee, Sang Hun
AU - Kim, Bum Joon
AU - Cha, Jae Kwan
AU - Kim, Dae Hyun
AU - Young Kim, Rae
AU - Sohn, Sang Wuk
AU - Shim, Dong Hyun
AU - Lee, Hyungjin
AU - Nah, Hyun Wook
AU - Sung, Sang Min
AU - Lee, Kyung Bok
AU - Lee, Jeong Yoon
AU - Yoon, Jee Eun
AU - Kim, Eung Gyu
AU - Seo, Jung Hwa
AU - Kim, Yong Won
AU - Hwang, Yangha
AU - Park, Man Seok
AU - Kim, Joon Tae
AU - Choi, Kang Ho
AU - Nam, Hyo Suk
AU - Heo, Ji Hoe
AU - Kim, Young Dae
AU - Hwang, In Gun
AU - Park, Hyung Jong
AU - Kim, Kyoung Sub
AU - Baek, Jang Hyun
AU - Song, Dong Beom
AU - Yoo, Joon Sang
AU - Park, Jong Moo
AU - Kwon, Ohyun
AU - Lee, Woong Woo
AU - Lee, Jung Ju
AU - Kang, Kyusik
AU - Kim, Byung Kun
AU - Lim, Jae Sung
AU - Oh, Mi Sun
AU - Yu, Kyung Ho
AU - Hong, Bora
AU - Jang, Mihoon
AU - Jang, Seyoung
AU - Jin, Jung Eun
AU - Kim, Jei
AU - Jeong, Hye Seon
AU - Hong, Keun Sik
AU - Park, Hong Kyun
AU - Cho, Yong Jin
AU - Bang, Oh Young
AU - Seo, Woo Keun
AU - Chung, Jongwon
N1 - Publisher Copyright: © 2016 International Multidisciplinary Scientific Geoconference. All rights reserved.
PY - 2020
Y1 - 2020
N2 - 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.
AB - 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.
KW - angiography
KW - aorta
KW - cholesterol, LDL
KW - informed consent
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85082342786&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.119.028718
DO - 10.1161/STROKEAHA.119.028718
M3 - Article
C2 - 32078484
AN - SCOPUS:85082342786
SN - 0039-2499
SP - 1231
EP - 1239
JO - Stroke
JF - Stroke
ER -