Lower LDL-C target a better bet for adverse CV event prevention after stroke

A treatment strategy of targeting a low-density lipoprotein cholesterol (LDL-C) of <70 mg/dL leads to a significant reduction in the composite of adverse cardiovascular (CV) events in patients who have had stroke as compared with an LDL-C target of 100 mg/dL, according to data from the Treat Stroke to Target (TST) trial.

TST included 2,860 patients who had 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 randomly assigned to a target LDL cholesterol of <70 mg/dL or 100±10 mg/dL (control), using statin and/or ezetimibe as needed. LDL measurements were conducted repeatedly (median 5 per patient) during 3.9 years of follow-up.

Patients in the lower LDL-C target group vs control group had a higher baseline LDL cholesterol and a lower LDL cholesterol compared with those in the lower target group (from 155 to 62 mg/dL vs from 121 to 74 mg/dL, respectively; p<0.001 for both).

The primary outcome of the composite of ischaemic stroke, myocardial infarction, new symptoms requiring urgent coronary or carotid revascularization, and vascular death occurred less frequently in the lower LDL-C target group (hazard ratio [HR], 0.61, 95 percent CI, 0.43–0.88; p=0.007). On the other hand, there was a nonsignificant reduction in the primary outcome in the control group (hazard ratio, 0.96, 95 percent CI, 0.73–1.26; p=0.75).

The findings suggest that the magnitude of LDL-C reduction may be equally important as the target level to achieve during treatment.