Statin plus ezetimibe combo for lower LDL-C targets effective at reducing stroke risk

Treatment with the combination of statin and ezetimibe to achieve a low-density lipoprotein cholesterol (LDL-C) target of <70 mg/dL works well to consistently reduce the risk of subsequent stroke, according to a post hoc analysis of the Treat Stroke to Target (TST) trial.

TST included 2,860 patients with ischaemic stroke in the previous 3 months or transient ischaemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis. They were randomized to a target LDL-C of <70 or 100 mg/dL using statin and/or ezetimibe, as needed.

Researchers assessed the composite of ischemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death as the primary study endpoint. They used Cox regression model to explore the relative effects of the combination of statin and ezetimibe (dual therapy) and statin monotherapy in achieving the lower vs higher LDL-C target and in reducing the risk of major vascular events.

In the lower target group, patients on dual therapy had a higher baseline LDL-C as compared with those on statin monotherapy (mean, 141 vs 131 mg/dL; p<0.001). The achieved LDL-C was 66.2 mg/dL with dual therapy and 64.1 mg/dL with statin monotherapy.

Relative to the higher target group, the lower target group on dual therapy had a significant reduction in the risk of the primary outcome (hazard ratio [HR], 0.60, 95 percent confidence interval [CI], 0.39–0.91; p=0.016). This benefit was not observed with statin monotherapy (HR, 0.92, 95 percent CI, 0.70–1.20; p=0.52). There was no significant increase in intracranial bleeding.