More Than 50 Percent Reduction in LDL Cholesterol in Patients With Target LDL

Media type: E-Article
Title: More Than 50 Percent Reduction in LDL Cholesterol in Patients With Target LDL
Contributor: 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; [...]
imprint: Ovid Technologies (Wolters Kluwer Health), 2023
Published in: Stroke, 54 (2023) 8, Seite 1993-2001
Language: English
DOI: 10.1161/strokeaha.123.042621
ISSN: 0039-2499; 1524-4628
Keywords: Advanced and Specialized Nursing ; Cardiology and Cardiovascular Medicine ; Neurology (clinical)
Origination:
Footnote:
Description: <jats:sec> <jats:title>BACKGROUND:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>METHODS:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS:</jats:title> <jats:p> 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, <jats:italic>P</jats:italic> <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]; <jats:italic>P</jats:italic> =0.007) and patients with <50% LDL reduction from baseline had little reduction (hazard ratio, 0.96 [95% CI, 0.73–1.26]; <jats:italic>P</jats:italic> =0.75). </jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS:</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>REGISTRATION:</jats:title> <jats:p> URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.clinicaltrials.gov">https://www.clinicaltrials.gov</jats:ext-link> ; Unique identifier: NCT01252875. URL: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://clinicaltrialsregister.eu">https://clinicaltrialsregister.eu</jats:ext-link> ; Unique identifier: EUDRACT2009-A01280-57. </jats:p> </jats:sec>

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