학술논문
More Than 50 Percent Reduction in LDL Cholesterol in Patients With Target LDL <70 mg/dL After a Stroke
Document Type
Academic Journal
Author
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
Source
Stroke. Aug 01, 2023 54(8):1993-2001
Subject
Language
English
ISSN
0039-2499
Abstract
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.