缺血性腦卒中後嚴控LDL膽固醇水平可降低心血管事件風險
作者：
小柯機器人發布時間：2019/11/19 15:55:00
法國巴黎比查特醫院Pierre Amarenco團隊的一項最新研究，比較了缺血性腦卒中後低密度脂蛋白膽固醇兩種控制目標的結果。這一研究成果2019年11月18日發表在國際頂尖學術期刊《新英格蘭醫學雜誌》上。
短暫性腦缺血發作（TIA）和動脈粥樣硬化性缺血性卒中後，一般建議對患者採用他汀類藥物進行強化降脂治療。而卒中後為降低心血管事件的發生率，低密度脂蛋白（LDL）膽固醇控制的目標水平仍有待研究。
這項在法國和韓國進行的平行組試驗中，研究組招募了2860名3個月內發生缺血性卒中或15天內發生TIA的患者，將其隨機分組，其中1430名將LDL膽固醇水平控制在70 mg/dL以下（低目標組），1430名控制在90-110 mg/dL（高目標組）。所有患者都有腦血管或冠狀動脈硬化的跡象，並接受他汀類藥物或伊澤替米治療。
兩組患者基線時的LDL膽固醇水平為135 mg/dL，平均隨訪3.5年後，低目標組為65 mg/dL，高目標組為96 mg/dL。低目標組中有121例（8.5%）患者發生缺血性卒中、心肌梗死、致緊急冠脈或頸動脈血管重建的新症狀或心血管原因死亡，高目標組中為156例（10.9%），差異顯著。兩組患者中顱內出血和新發糖尿病的發生率無顯著差異。
總之，當缺血性中風或TIA並伴有動脈粥樣硬化跡象時，將LDL膽固醇水平控制在70 mg/dL以下，與90-110 mg/dL相比，可顯著降低心血管事件的風險。
附：英文原文
Title: A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke
Author: Pierre Amarenco, M.D.,, Jong S. Kim, M.D.,, Julien Labreuche, B.S.T.,, Hugo Charles, B.S.T.,, Jérémie Abtan, M.D.,, Yannick Béjot, M.D.,, Lucie Cabrejo, M.D.,, Jae-Kwan Cha, M.D.,, Grégory Ducrocq, M.D., Ph.D.,, Maurice Giroud, M.D.,, Celine Guidoux, M.D.,, Cristina Hobeanu, M.D.,, Yong-Jae Kim, M.D.,, Bertrand Lapergue, M.D., Ph.D.,, Philippa C. Lavallée, M.D.,, Byung-Chul Lee, M.D.,, Kyung-Bok Lee, M.D.,, Didier Leys, M.D.,, Marie-Hélène Mahagne, M.D.,, Elena Meseguer, M.D.,, Norbert Nighoghossian, M.D.,, Fernando Pico, M.D., Ph.D.,, Yves Samson, M.D.,, Igor Sibon, M.D.,, P. Gabriel Steg, M.D.,, Sang-Min Sung, M.D.,, Pierre-Jean Touboul, M.D.,, Emmanuel Touzé, M.D., Ph.D.,, Olivier Varenne, M.D., Ph.D.,, éric Vicaut, M.D.,, Nessima Yelles,, and Eric Bruckert, M.D.
Issue&Volume: November 18, 2019
Abstract:
Background
The use of intensive lipid-lowering therapy by means of statin medications is recommended after transient ischemic attack (TIA) and ischemic stroke of atherosclerotic origin. The target level for low-density lipoprotein (LDL) cholesterol to reduce cardiovascular events after stroke has not been well studied.
Methods
In this parallel-group trial conducted in France and South Korea, we randomly assigned patients with ischemic stroke in the previous 3 months or a TIA within the previous 15 days to a target LDL cholesterol level of less than 70 mg per deciliter (1.8 mmol per liter) (lower-target group) or to a target range of 90 mg to 110 mg per deciliter (2.3 to 2.8 mmol per liter) (higher-target group). All the patients had evidence of cerebrovascular or coronary-artery atherosclerosis and received a statin, ezetimibe, or both. The composite primary end point of major cardiovascular events included ischemic stroke, myocardial infarction, new symptoms leading to urgent coronary or carotid revascularization, or death from cardiovascular causes.
Results
A total of 2860 patients were enrolled and followed for a median of 3.5 years; 1430 were assigned to each LDL cholesterol target group. The mean LDL cholesterol level at baseline was 135 mg per deciliter (3.5 mmol per liter), and the mean achieved LDL cholesterol level was 65 mg per deciliter (1.7 mmol per liter) in the lower-target group and 96 mg per deciliter (2.5 mmol per liter) in the higher-target group. The trial was stopped for administrative reasons after 277 of an anticipated 385 end-point events had occurred. The composite primary end point occurred in 121 patients (8.5%) in the lower-target group and in 156 (10.9%) in the higher-target group (adjusted hazard ratio, 0.78; 95% confidence interval, 0.61 to 0.98; P=0.04). The incidence of intracranial hemorrhage and newly diagnosed diabetes did not differ significantly between the two groups.
Conclusions
After an ischemic stroke or TIA with evidence of atherosclerosis, patients who had a target LDL cholesterol level of less than 70 mg per deciliter had a lower risk of subsequent cardiovascular events than those who had a target range of 90 mg to 110 mg per deciliter. (Funded by the French Ministry of Health and others; Treat Stroke to Target ClinicalTrials.gov number, NCT01252875.)
DOI: 10.1056/NEJMoa1910355
Source: https://www.nejm.org/doi/full/10.1056/NEJMoa1910355