In patients with a recent ischemic stroke or transient ischemic attack (TIA) with evidence of atherosclerotic disease, having a lower LDL-C level of less than 70 mg per deciliter "had a lower risk of a composite end point of major cardiovascular events" vs. higher LDL-C levels, according to results of the Treat Stroke to Target Trial presented Nov. 18 during AHA 2019 in Philadelphia, PA, and simultaneously published in the New England Journal of Medicine.

Pierre Amarenco, MD, et al., looked at 2,860 patients at 77 sites in France and South Korea who had an ischemic stroke in the previous three months or a TIA within the previous 15 days. All patients received statin with or without ezetimibe, and patients were randomly assigned to a low-target group with a target of LDL-C less than 70 mg per deciliter vs. a high-target group with a target of LCL-C from 90 mg to 110 mg per deciliter and were followed for a median of 3.5 years.

Results showed that the primary end point of a composite of major cardiovascular events – ischemic stroke, myocardial infarction, new symptoms leading to urgency coronary or carotid revascularization or death from cardiovascular cases – occurred in 121 patients in the low-target group vs. 156 in the high-target group. However, the investigators note that the trial was stopped early after 277 of 385 anticipated end-point events occurred.

The researchers conclude that patients with a lower target LDL-C level had "a lower risk of subsequent cardiovascular events" than those with a higher target LDL-C level.

In a related editorial comment, Lawrence R. Wechsler, MD, notes, "the trial provides evidence to support the original concept of statins as an agent to reduce cardiovascular risk, primarily by reducing cholesterol levels." He adds that the question if LDL-C is the "only and best target to reach this goal" should be further explored "to fine-tune our approach in terms of risks and benefits."

Keywords: AHA19, AHA Annual Scientific Sessions, Cholesterol, LDL, Stroke, Brain Ischemia, Atherosclerosis, Cholesterol, HDL, Primary Prevention, Dyslipidemias, Acute Coronary Syndrome

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