Lower LDL-C Target May Help Prevent Vascular Events Following Ischemic Stroke

Pierre Amarenco, MD

This article was originally published on MDMag.com, part of the HCPLive Network.

Findings from a study presented at the American Stroke Association’s International Stroke Conference 2020 suggests that an LDL-C of less than 70 mg/dL in caucasian patients lowers the risk of major vascular events following ischemic stroke.

Data from the French cohort (n = 1073) of the Treat Stroke to Target (TST) trial indicated that the aggressive cholesterol target could prevent 1 in 4 major vascular events in the population.

The TST trial was a multicenter trial that randomized 2860 patients who recently experienced an atherothrombotic ischemic stroke in the past 3 months or transient ischemic attack (TIA) in 1:1 ratio to an LDL-C target of less than 70 mg/dL or an LDL of 100±10 mg/dL using statins or ezetimibe. The French cohort data presented at ISC 20 examined 1073 patients with a follow-up of 5.3 years, which was almost 2 years more than the 3.5 years of follow-up from the AHA 2019 presentation.

The trial had a composite endpoint of nonfatal ischemic stroke or myocardial infarction, news symptoms requiring urgent coronary or carotid revascularization, and vascular death. In the entire TST study cohort, the endpoint was achieved in 8.5% of patients in those with a target of less than 70 mg/dL and in 10.9% in the 100±10 mg/dL group (HR 0.78, 95% CI, 0.61-0.98; P = .036).

Of the 2860 patients, 1073 were randomized to a target of less than 70 mg/dL and 1075 were randomized to the 100±10 mg/dL group—mean LDL-C achieved after a median 5.3 years of follow-up was 66 mg/dL and 96 mg/dL, respectively. In the entire TST cohort, the mean LDL-C achieved for the groups was 65 mg/dL and 96 mg/dL.

In the French cohort, the primary outcome occurred in 9.6% of patients in the lower target group and 12.9% of patients in the 100±10 mg/dL group (HR 0.74, 95% CI, 0.75-0.94; P = .019). Investigators also pointed out cerebral infarction and urgent carotid revascularization following TIA was reduced by 27% (P = .046) and cerebral infarction or intracranial hemorrhage was reduced by 28% (P = .023) in patients with a target of less than 70 mg/dL.

When examining the primary outcome or intracranial hemorrhage, results indicated a 25% in these type of events (P = .022). An association was observed between a lower target LDL-C and intracranial hemorrhages—with 13 patients experiencing such an event in the lower target group versus 11 patients in the higher target group (HR 1.17, 95% CI, 0.53-2.62, P = .70). This is similar to an effect seen in the entire TST cohort (1.3% versus 0.9%; HR 1.38, 95% CI 0.68-2.82).

Results of an NNT analysis indicated a target LDL-C of less than 70 mg/dL avoided 1 subsequent major vascular event in 4 (NNT=30) in a Caucasian population.

For more coverage of ISC 2020, click here.

REFERENCE

Amarenco P, Kim JS, Labreuche J, et al; on behalf of the Treat Stroke to Target investigators. Benefit of Targeting a LDL Cholesterol Less than 70 mg/dL after an Ischemic Stroke of Atherosclerotic Origin. The 5-year Results of the French Part of the TST Trial. Presented at: 2020 International Stroke Conference. February 19-21, 2020; Los Angeles, CA. Abstract LB9.