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Targeting LDL-C <70 mg/dL is better than 100 mg/dL after stroke

Presented by
Prof. Pierre Amarenco, Xavier Bichat Medical School and Denis Diderot University, France
AHA 2019
Treat Stroke to Target
A large trial evaluated the reduction in cardiovascular (CV) events by targeting low-density lipoprotein cholesterol (LDL-C) <70 mg/dL after atherothrombotic ischaemic stroke compared with a target of LDL-C 100 ± 10 mg/dL, concluding that treating to target LDL-c <70 mg/dL confers a lower risk of recurrent ischaemic events.

The Treat Stroke to Target trial 3.5-year follow-up data were presented by Prof. Pierre Amarenco (Xavier Bichat Medical School and Denis Diderot University, France) [1]. This open-label trial randomised patients who had had an atherothrombotic ischaemic stroke in the past 3 months or a transient ischaemic attack (TIA) in the past 15 days (n=2,860) to either a LDL-C target of <70 mg/dL or a target of 100 mg/dL (±10 mg/dL) using statins and/or other lipid lowering therapy (e.g. ezetimibe).

The primary endpoint was a composite of ischaemic stroke, myocardial infarction (MI), new symptoms requiring urgent coronary or carotid revascularisation, and death. The primary endpoint occurred in 8.5% patients in the arm targeting <70 mg/dL versus 10.9% of patients in the target 100 mg/dL arm (adjusted HR 0.78; 95% CI 0.61-0.98; P=0.036; see Table). A large number of secondary endpoints were also evaluated (see Table).

Table: Primary and secondary endpoint results comparing the 2 LDL-C targets of the Treat Stroke to Target trial [1]

** P-values for additional secondary endpoints were not calculated, as there was no significant between-group difference for the first endpoint on hierarchical testing.HR, hazard ratio; LDL-C, low-density lipoprotein cholesterol; TIA, transient ischaemic attack.

The authors concluded that after an atherothrombotic ischaemic stroke, targeting LDL-C <70 mg/dL lowered the risk for CV events more than the 100±10 mg/dL target. The results were recently published in full in the New England Journal of Medicine [2].

    1. Amerenco P, et al. Treat stroke to target- Benefit of a target LDL cholesterol less than 70 mg/dl after ischemic stroke due to atherosclerosis. LBS06, AHA Scientific Sessions 2019, 14-18 November, Philadelphia, USA.
    2. Amarenco P, et al. A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med 2020 Jan 2;382(1):9.

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