Carotid Atherosclerosis Evolution When Targeting a Low-Density Lipoprotein Cholesterol Concentration <70 mg/dL After an Ischemic Stroke of Atherosclerotic Origin

Abstract

Background: The Treat Stroke to Target (TST) trial showed the benefit of targeting a low-density lipoprotein cholesterol (LDL-C) concentration of Methods: TST-PLUS (Treat Stroke to Target-PLaque Ultrasound Study) included 201 patients assigned to a LDL-C concentration of TM software at baseline, and at 2, 3, and 5 years. All images were up-loaded to the Intelligence in Medical Technology (IMT^TM) database directly from the carotid ultrasound device. The central core laboratory performed all off-line 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 origin using the definition of the Mannheim consensus definition, and the between-group comparison of common carotid arteries intima-media thickness (CCA-IMT) change. Results: 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 CCA-IMT 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], P=0.004). Conclusions: In patients with ischemic stroke and atherosclerosis, an LDL-C target of Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT01252875