Yield of Dual Therapy With Statin and Ezetimibe in the Treat Stroke to Target Trial - Archive ouverte HAL
Article Dans Une Revue Stroke Année : 2022

Yield of Dual Therapy With Statin and Ezetimibe in the Treat Stroke to Target Trial

Pierre Amarenco
Jong Kim
  • Fonction : Auteur
Julien Labreuche
Hugo Charles
  • Fonction : Auteur
Maurice Giroud
Byung-Chul Lee
Philippa Lavallée
Marie-Hélène Mahagne
  • Fonction : Auteur
Elena Meseguer
Norbert Nighoghossian
Philippe Gabriel Steg
Éric Vicaut

Résumé

Background: In atherosclerotic stroke, lipid-lowering treatment with a target LDL (low-density lipoprotein) cholesterol of <70 compared with 100±10 mg/dL reduced the risk of subsequent cardiovascular events. This post hoc analysis explored the relative effects of the combination of statin and ezetimibe (dual therapy) and statin monotherapy in achieving the lower LDL cholesterol target and in reducing the risk of major vascular events, as compared with the higher target group. Methods: 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 or 100±10 mg/dL, using statin and/or ezetimibe as needed. 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. Results: Among 2860 patients enrolled, patients who were on dual therapy during the trial in the lower target group had a higher baseline LDL cholesterol as compared to patients on statin monotherapy (141±38 versus 131±36, respectively, P <0.001). In patients on dual therapy and on statin monotherapy, the achieved LDL cholesterol was 66.2 and 64.1 mg/dL respectively, and the primary outcome was reduced during dual therapy as compared with the higher target group (HR, 0.60 [95% CI, 0.39–0.91]; P =0.016) but not during statin monotherapy (HR, 0.92 [95% CI, 0.70–1.20]; P =0.52), with no significant increase in intracranial bleeding. Conclusions: In the TST trial (Treat Stroke to Target), targeting an LDL cholesterol of < 70 mg/dL with a combination of statin and ezetimibe compared with 100±10 mg/dL consistently reduced the risk of subsequent stroke. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01252875. URL: clinicaltrialsregister.eu ; Unique identifier: EUDRACT2009-A01280-57.

Dates et versions

hal-03967324 , version 1 (01-02-2023)

Identifiants

Citer

Pierre Amarenco, Jong Kim, Julien Labreuche, Hugo Charles, Maurice Giroud, et al.. Yield of Dual Therapy With Statin and Ezetimibe in the Treat Stroke to Target Trial. Stroke, 2022, 53 (11), pp.3260-3267. ⟨10.1161/STROKEAHA.122.039728⟩. ⟨hal-03967324⟩
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