Amarenco Pierre, Hobeanu Cristina, Labreuche Julien, Charles Hugo, Giroud Maurice, Meseguer Elena, Lavallée Philippa C, Gabriel Steg Philippe, Vicaut Éric, Bruckert Eric, Touboul Pierre-Jean
Department of Neurology and Stroke Center (P.A., C.H., H.C., E.M., P.C.L., P.-J.T.).
EA 2694-Santé Publique: Épidémiologie et Qualité des Soins, Université Lille, CHU Lille, France (J.L.).
Circulation. 2020 Aug 25;142(8):748-757. doi: 10.1161/CIRCULATIONAHA.120.046774. Epub 2020 Jun 29.
The TST trial (Treat Stroke to Target) showed the benefit of targeting a low-density lipoprotein cholesterol (LDL-C) concentration of <70 mg/dL in terms of reducing the risk of major cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature. The impact on carotid atherosclerosis evolution is not known.
TST-PLUS (Treat Stroke to Target-Plaque Ultrasound Study) included 201 patients assigned to an LDL-C concentration of <70 mg/dL and 212 patients assigned to a target of 100±10 mg/dL. To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe as needed. Ultrasonographers were certified and carotid ultrasound examinations were performed using M'Ath software at baseline and at 2, 3, and 5 years. All images were uploaded to the Intelligence in Medical Technologies database directly from the carotid ultrasound device. The central core laboratory performed all offline measurements of the intima-media thickness of both common carotid arteries blinded from the randomization arm. The main outcomes were newly diagnosed atherosclerotic plaque on carotid bifurcation or internal carotid artery using the Mannheim consensus definition and between-group comparison of common carotid arteries intima-media thickness change.
After a median follow-up of 3.1 years, the achieved LDL-C concentrations were 64 mg/dL (1.64 mmol/L) in the lower-target group and 106 mg/dL (2.72 mmol/L) in the higher-target group. Compared with the higher-target group, patients in the lower-target group had a similar incidence of newly diagnosed carotid plaque: 46/201 (5-year rate, 26.1%) versus 45/212 (5-year rate, 29.7%). The change in common carotid arteries intima-media thickness was -2.69 µm (95% CI, -6.55 to 1.18) in the higher-target group and -10.53 µm (95% CI, -14.21 to -6.85) in the lower-target group, resulting in an absolute between-group difference of -7.84 µm (95% CI, -13.18 to -2.51; =0.004).
In patients with ischemic stroke and atherosclerosis, an LDL-C target of <70 mg/dL (1.8 mmol/L) did not reduce the incidence of new carotid plaques but produced significantly greater regression of carotid atherosclerosis than an LDL-C target of 90 to 110 mg/dL. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01252875.
TST试验（治疗卒中达靶目标）显示，在2860例患有脑动脉粥样硬化狭窄的缺血性卒中患者中，将低密度脂蛋白胆固醇（LDL-C）浓度目标设定为<70mg/dL可降低主要心血管事件风险。其对颈动脉粥样硬化进展的影响尚不清楚。
TST-PLUS（治疗卒中达靶目标-斑块超声研究）纳入了201例被分配至LDL-C浓度<70mg/dL的患者和212例被分配至100±10mg/dL目标的患者。为实现这些目标，研究者使用了他们选择的他汀类药物及其剂量，并根据需要加用依折麦布。超声检查人员具备资质，在基线、2年、3年和5年时使用M'Ath软件进行颈动脉超声检查。所有图像直接从颈动脉超声设备上传至医疗技术情报数据库。中心核心实验室对双侧颈总动脉内膜中层厚度进行所有离线测量，测量人员对随机分组情况不知情。主要结局为根据曼海姆共识定义新诊断的颈动脉分叉或颈内动脉粥样硬化斑块，以及组间颈总动脉内膜中层厚度变化的比较。
中位随访3.1年后，低目标组实现的LDL-C浓度为64mg/dL（1.64mmol/L），高目标组为106mg/dL（2.72mmol/L）。与高目标组相比，低目标组新诊断颈动脉斑块的发生率相似：46/201（5年发生率，26.1%）对45/212（5年发生率，29.7%）。高目标组颈总动脉内膜中层厚度变化为-2.69μm（95%CI，-6.55至1.18），低目标组为-10.53μm（95%CI，-14.21至-6.85），组间绝对差异为-7.84μm（95%CI，-13.18至-2.51；P=0.004）。
在缺血性卒中和动脉粥样硬化患者中，LDL-C目标<70mg/dL（1.8mmol/L）并未降低新的颈动脉斑块发生率，但与LDL-C目标为90至110mg/dL相比，颈动脉粥样硬化的消退更为显著。注册信息：网址：https://www.clinicaltrials.gov；唯一标识符：NCT01252875。
