BACKGROUND The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied. METHODS In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes. RESULTS A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P = 0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups. CONCLUSIONS After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.).

中文翻译：

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缺血性中风后两种低密度脂蛋白胆固醇目标的比较。

背景 在短暂性脑缺血发作 (TIA) 和动脉粥样硬化起源的缺血性卒中后，建议使用他汀类药物进行强化降脂治疗。用于减少卒中后心血管事件的低密度脂蛋白 (LDL) 胆固醇目标水平尚未得到充分研究。方每升）（较低目标组）或目标范围为 90 毫克至 110 毫克每分升（2.3 至 2.8 毫摩尔每升）（较高目标组）。所有患者都有脑血管或冠状动脉粥样硬化的证据，并接受了他汀类药物、依折麦布或两者的治疗。主要心血管事件的复合主要终点包括缺血性卒中、心肌梗死、导致紧急冠状动脉或颈动脉血运重建的新症状或心血管原因死亡。结果 共有 2860 名患者入组，中位随访时间为 3.5 年；1430 人被分配到每个 LDL 胆固醇目标组。基线时的平均 LDL 胆固醇水平为 135 mg/dL（3.5 mmol/L），低目标组的平均 LDL 胆固醇水平为 65 mg/dL（1.7 mmol/L）和 96 mg/dL（2.5 mmol/L）在更高的目标组中。在预期的 385 个终点事件中的 277 个发生后，该试验因行政原因停止。复合主要终点发生在低目标组的 121 名患者 (8.5%) 和 156 名 (10. 9%）在更高的目标组（调整后的风险比，0.78；95% 置信区间，0.61 至 0.98；P = 0.04）。两组颅内出血和新诊断糖尿病的发生率无显着差异。结论：在有动脉粥样硬化证据的缺血性卒中或 TIA 后，目标 LDL 胆固醇水平低于 70 mg/dL 的患者发生后续心血管事件的风险低于目标范围为 90 mg/dL 至 110 mg/dL 的患者。 . （由法国卫生部和其他机构资助；Treat Stroke to Target ClinicalTrials.gov 编号，NCT01252875。）。两组颅内出血和新诊断糖尿病的发生率无显着差异。结论：在有动脉粥样硬化证据的缺血性卒中或 TIA 后，目标 LDL 胆固醇水平低于 70 mg/dL 的患者发生后续心血管事件的风险低于目标范围为 90 mg/dL 至 110 mg/dL 的患者。 . （由法国卫生部和其他机构资助；Treat Stroke to Target ClinicalTrials.gov 编号，NCT01252875。）。两组颅内出血和新诊断糖尿病的发生率无显着差异。结论：在有动脉粥样硬化证据的缺血性卒中或 TIA 后，目标 LDL 胆固醇水平低于 70 mg/dL 的患者发生后续心血管事件的风险低于目标范围为 90 mg/dL 至 110 mg/dL 的患者。 . （由法国卫生部和其他机构资助；Treat Stroke to Target ClinicalTrials.gov 编号，NCT01252875。）。