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.

中文翻译：

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在缺血性卒中后的5年内靶向LDL（低密度脂蛋白）胆固醇<70 mg / dL的益处。

背景与目的-TST试验（卒中至目标）评估了将LDL（低密度脂蛋白）胆固醇降至70 mg / dL以降低2860例缺血性卒中伴有动脉粥样硬化性狭窄的患者发生心血管事件的风险。在法国和韩国人群中，脑血管或主动脉弓斑> 4 mm。法国患者的随访时间中位数为5.3年（与SPARCL试验[通过降低胆固醇水平积极预防中风]的中位随访时间相似），而韩国患者的随访中位时间为2.0年。他汀类药物的暴露持续时间是降低心血管疾病风险的众所周知的驱动力。我们在此报告法国队列中的TST结果。方法-173名法国患者被分配为<70 mg / dL（1.8 mmol / L）和1075至100±10 mg / dL（90-110 mg / dL，2。3-2.8mmol / L）。为了实现这些目标，研究人员使用了他汀类药物和他们选择的剂量，并在需要时在上面加了依折麦布。主要结局是缺血性中风，心肌梗塞，需要紧急冠状动脉或颈动脉血运重建和血管死亡的新症状的综合结果。结果-经过5.3年的中位随访，平均LDL胆固醇分别为66（1.69 mmol / L）和96 mg / dL（2.46 mmol / L）。主要终点分别发生在9.6％和12.9％的患者中（HR，0.74 [95％CI，0.57-0.94]； P = 0.019）。短暂性脑缺血发作后脑梗塞或紧急颈动脉血运重建减少了27％（P = 0.046）。脑梗死或颅内出血减少了28％（P = 0.023）。主要结局或颅内出血减少了25％（P = 0.021）。颅内出血分别发生在13和11例患者中（HR，1.17 [95％CI，0.53-2.62]； P = 0.70）。结论-在记录有动脉粥样硬化起源的缺血性卒中后，在5.3年内将LDL胆固醇目标定为<70 mg / dL，避免了随后的4例主要血管事件（需要治疗30例），并且颅内出血没有增加。注册网址：https：//www.clinicaltrials.gov。唯一标识符：NCT01252875。