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101. Arterial wall properties in multiple spontaneous cervical artery dissection. An ultrasound study

Author

Karine Berthet, Christophe Tzourio, Lamia Benslamia, Benoit Guillon, Marie-Germaine Bousser, and Pierre Jean Touboul

Subjects
Advanced and Specialized Nursing, Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract

P120 Background: An underlying arteriopathy related to a generalized extracellular matrix defect is suspected in spontaneous cervical artery dissection. We selected patients with multiple spontaneous cervical artery dissection (MSCAD) to study carotid arteries morphology and common carotid arteries hemodynamic properties. Method: 12 patients with MSCAD (mean age 48±6, 50% of women) were consecutively and prospectively included during an eighteen month period and were compared with 12 ischemic stroke patients matched for age and sex. Cases and controls had ultrasound measurement of each common carotid artery diameter change in systole and diastole, during 3 to 5 cardiac cycles. This parameter was expressed as percentage. Post-processing of the ultrasonic signals was performed using computer-assisted image analysis. Results: There was no difference in diameter of common carotid and internal carotid arteries between cases and controls, just as intima-media thickness measurement. Whereas, the average of common carotid artery relative diameter change was significantly higher in cases than in controls (13.6% versus 10.6%, p=0.005) Conclusion: As common carotid artery relative diameter change is a one-dimensional assessment reflecting the elastic properties of the artery wall, our preliminary results suggest that an underlying arteriopathy may be present in multiple spontaneous cervical artery dissection.

Published
2001
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102. Extracranial vertebral artery dissection

Author

Pierre-Jean Touboul, J L Mas, and Marie-Germaine Bousser

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Vertebral artery dissection, Magnetic resonance imaging, Aneurysm dissecting, medicine.disease, Surgery, Psychiatry and Mental health, Text mining, Carotid artery.internal, medicine, Neurology (clinical), Radiology, Vertebrobasilar insufficiency, Differential diagnosis, business
Published
1992
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103. Carotid artery intima media thickness, plaque and framingham cardiovascular score in Asia, Africa/Middle East and Latin America: the PARC-AALA Study.

Author

Pierre-Jean Touboul, Rafael Hernández-Hernández, Serdar Küçükoğlu, Kam-Sang Woo, Eric Vicaut, Julien Labreuche, Chris Migom, Honorio Silva, and Raul Vinueza

Abstract

Abstract Objective  The PARC-AALA (Paroi art�rielle et Risque Cardiovasculaire in Asia Africa/ Middle East and Latin America) study was designed to evaluate the correlation between intima-media thickness of the common carotid artery (CCAIMT), carotid plaque and absolute cardiovascular risk in a multi-ethnic population. Methods  An international, cross-sectional, study including 79 centres from 21 countries in Asia, Africa, the Middle East and Latin America. Two thousand three hundred and twenty-eight subjects, meeting all inclusion criteria, were stratified by risk factors groups (no modifiable factor or at least both uncontrolled hypertension and hypercholesterolemia). CCAIMT, presence of plaque and cardiovascular risk factors were assessed for each individual. Results  Some intergeographical characteristics in demographics, and risk factors were found accompanying early atherosclerosis marker differences. In Asia where the subjects were at lower risk, the mean CCAIMT was 4% lower than in Africa/Middle East and Latin America. On multiple linear regression analysis CCAIMT and carotid plaque were independently associated with increased Framingham cardiovascular score (FCS) without heterogeneity across geographic regions. CCAIMT and carotid plaque explained roughly 20% of the FCS in both genders. Conclusion  The PARC-AALA study confirms the correlation between CCAIMT and FCS in three different populations. Intima-media thickness (IMT) and plaque evaluation may represent a complementary predictive tool for detection of cardiovascular disease in individuals. [ABSTRACT FROM AUTHOR]

Published
2007

105. Author Index / Subject Index Vol. 4 (suppl 4) 1994

Author

Michael Daffertshofer, Julien Bogousslavsky, John W. Harbison, James F. Toole, Ralph L. Sacco, Harold P. Adams, Marc Fisher, Pierre-Jean Touboul, Saran Jonas, Gudrun Boysen, and M.G. Hennerici

Subjects
Gerontology, Index (economics), Neurology, business.industry, Medicine, Subject (documents), Neurology (clinical), Cardiology and Cardiovascular Medicine, business
Published
1994
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106. Spontaneous dissecting aneurysms of the internal carotid and vertebral arteries--two case reports

Author

J Chiras, Pierre-Jean Touboul, J M Verret, J L Mas, C Goeau, and Marie-Germaine Bousser

Subjects
Adult, Carotid Artery Diseases, medicine.medical_specialty, Carotid arteries, Angiopathy, Text mining, medicine, Humans, Vertebral Artery, Advanced and Specialized Nursing, medicine.diagnostic_test, business.industry, Spontaneous dissection, Intracranial Aneurysm, Heparin, medicine.disease, Surgery, Radiography, Dissecting Aneurysms, Aortic Dissection, Dysplasia, Acute Disease, Angiography, Female, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, Carotid Artery, Internal, medicine.drug
Abstract

Two patients had acute spontaneous dissection of both internal carotid arteries and of one or both vertebral arteries. One had angiographic signs suggestive of fibro-muscular dysplasia and both were on oral contraceptives. They were treated with high dose heparin and made a good clinical recovery. A digital intravenous angiography performed two to three months later showed a complete recanalization of arteries involved. These patients are similar to those reported as "idiopathic regressing arteriopathy" and "reversible angiopathy" which probably correspond to the same entity.

Published
1985
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107. 'AICLA' controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia

Author

N Thibult, J M Lefaucconnier, Marie-Germaine Bousser, Haguenau M, Pierre-Jean Touboul, Touboul D, and Eveline Eschwège

Subjects
Adult, Male, Risk, medicine.medical_specialty, Randomization, Arteriosclerosis, Subgroup analysis, Placebo, Gastroenterology, law.invention, Placebos, Randomized controlled trial, law, Internal medicine, medicine, Humans, Myocardial infarction, Aged, Advanced and Specialized Nursing, Clinical Trials as Topic, Aspirin, Cerebral infarction, business.industry, Cerebral Infarction, Dipyridamole, Middle Aged, medicine.disease, Long-Term Care, Ischemic Attack, Transient, Anesthesia, Patient Compliance, Drug Therapy, Combination, Female, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, medicine.drug
Abstract

604 Patients with atherothrombotic cerebral ischemic events (transient, 16%: or completed, 84%) referrable either to the carotid or to the vertebral-basilar circulation were entered into a double blind randomized clinical trial (AICLA) to determine whether aspirin (A) (1 g/day) or aspirin (1 g/day) + Dipyridamole (225 mg/day) (AD) would produce a significant reduction in the subsequent (3 years) occurrence of fatal and nonfatal cerebral infarction. Randomization produced remarkably comparable treatment groups and this good comparability was maintained throughout the study. Adherence to the protocol and drug compliance were excellent. Side effects, particularly symptoms of peptic ulcer and hemorrhagic events were significantly (p less than 0.03) more frequent in the two treatment groups containing aspirin. With the exception of patients who withdrew from the study, each patient was followed for 3 years. At the end of the study, the number of fatal and nonfatal cerebral infarctions was 31 in the placebo (P) group, 17 in the A group and 18 in the AD group. Taking into account the duration of follow-up for each patient, these figures correspond to cumulative rates of 18% in the P group and 10.5% in each of the 2 active treatment groups. Analysis with the Mantel Method showed: 1)--A difference at the 6% level between the 3 groups and between P and AD; 2)--A difference at the 5% level between P and A; 3)--No difference between (A and AD; 4)--A difference at the 2% level between the P group and the two treated groups taken together (A + AD). Among other diseases occurring during the trial, the only significant difference concerned myocardial infarction, which was less frequent in the 2 treated groups (P less than 0.05). Subgroup analysis failed to show a significant sex difference in the efficacy of aspirin. It is concluded that, in patients comparable to those defined in the protocol, Aspirin (1 g) has a significantly beneficial effect in the secondary prevention of atherothrombotic cerebral infarction.

Published
1983
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108. Duplex scanning in extracranial vertebral artery dissection

Author

J L Mas, Pierre-Jean Touboul, Laplane D, and Marie-Germaine Bousser

Subjects
Adult, Advanced and Specialized Nursing, medicine.medical_specialty, business.industry, Vertebral artery dissection, Vertebral artery, Hemodynamics, Dissection (medical), medicine.disease, Duplex scanning, Aortic Dissection, Stenosis, medicine.anatomical_structure, medicine.artery, Occlusion, medicine, Humans, Female, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business, Vertebral Artery, Ultrasonography, Artery
Abstract

Ultrasonic (duplex scanning and continuous-wave Doppler) and angiographic findings in three patients with bilateral extracranial vertebral artery dissection are reported. A pattern of ultrasonic anomalies diagnostic of dissection is described, including association of a localized increase in diameter of the artery with hemodynamic signs of stenosis or occlusion at the same level and decreased pulsatility and presence of intravascular echoes in the enlarged segment.

Published
1988
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109. Acute myocardial infarction : Measurement of arachidonate end-products in whole blood as an index of platelet cyclo-oxygenase activity in vivo

Author

Marc Dechavanne, Pierre-Jean Touboul, D. Rousson, and Michel Lagarde

Subjects
Blood Platelets, Male, medicine.medical_specialty, Lipoxygenase, Myocardial Infarction, 6-Ketoprostaglandin F1 alpha, Arachidonic Acids, chemistry.chemical_compound, In vivo, Internal medicine, Hydroxyeicosatetraenoic Acids, medicine, Humans, Platelet, 12-Hydroxy-5,8,10,14-eicosatetraenoic Acid, Platelet activation, Whole blood, Arachidonic Acid, biology, business.industry, Hematology, Middle Aged, Thromboxane B2, Endocrinology, chemistry, Biochemistry, Eicosanoid, Prostaglandin-Endoperoxide Synthases, Fatty Acids, Unsaturated, biology.protein, lipids (amino acids, peptides, and proteins), Cyclooxygenase, business, Ex vivo
Abstract

The endogenous arachidonic acid metabolism was investigated ex vivo, in separated serum from clotted whole blood, soon after the onset of acute myocardial infarction (3.3 +/- 0.7 hr). A group of eight consecutive male patients was selected, since no evidence was obtained of any associated disease known to increase platelet activity or any recent exposure to cyclo-oxygenase inhibitors. This group of patients compared to an age and sex matched control group showed a large decrease in the platelet cyclo-oxygenase end-products in whole blood: thromboxane B2 (TXB2), 12-hydroxy-5-cis, 8-cis, 10-trans-heptadecatrienoic acid (HHT) and 6-keto-PGF1 alpha (p less than .01). In addition, platelet lipoxygenase produced an increased amount of 12-hydroperoxy-5,8,10,14-eicosatetraenoic acid (12-HPETE) as measured by its reduced metabolite 12-HETE (p less than .05). Furthermore, the TXB2 plasma concentration was significantly elevated in patients (p less than .01), confirming the enhanced platelet reactivity during the early stages of acute myocardial infarction. These results point out that a decreased level of cyclo-oxygenase end-products and an increased level of lipoxygenase end-product in serum is consistent with a previous in vivo cyclo-oxygenase hyperactivity.

Published
1987
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110. Rationale, design and population baseline characteristics of the PERFORM Vascular Project: an ancillary study of the Prevention of cerebrovascular and cardiovascular Events of ischemic origin with teRutroban in patients with a history oF ischemic strOke or tRansient ischeMic attack (PERFORM) trial

Author

Pierre-Jean Touboul, Michiel L. Bots, Ian Ford, Stephane Laurent, and Michael G. Hennerici

Subjects
Male, Brain ischemia, Carotid Stenosis, Pharmacology (medical), Carotid intima-media thickness, Antiatherosclerotic activity, Stroke, Aged, 80 and over, Ultrasonography, Doppler, Duplex, Aspirin, education.field_of_study, Ischemic stroke, Cerebral infarction, General Medicine, Middle Aged, Carotid plaque, Clinical trial, Carotid Arteries, Terutroban, Data Interpretation, Statistical, Cardiology, cardiovascular system, Platelet aggregation inhibitor, Female, Cardiology and Cardiovascular Medicine, medicine.drug, Quality Control, medicine.medical_specialty, Endpoint Determination, Population, Antiplatelet agent, Naphthalenes, Article, Double-Blind Method, Internal medicine, medicine, Humans, cardiovascular diseases, education, Aged, Pharmacology, Vascular disease, business.industry, Reproducibility of Results, Atherosclerosis, medicine.disease, Surgery, Epidemiologic Research Design, Sample Size, Propionates, Tunica Intima, business, Platelet Aggregation Inhibitors
Abstract

Purpose PERFORM is exploring the efficacy of terutroban versus aspirin for secondary prevention in patients with a history of ischemic stroke or transient ischemic attacks (TIAs). The PERFORM Vascular Project will evaluate the effect of terutroban on progression of atherosclerosis, as assessed by change in carotid intima-media thickness (CIMT) in a subgroup of patients. Methods and results The Vascular Project includes structural (CIMT, carotid plaques) and functional (carotid stiffness) vascular studies in all patients showing at least one carotid plaque at entry. Expected mean follow-up is 36 months. Primary endpoint is rate of change of CIMT. Secondary endpoints include emergent plaques and assessment of carotid stiffness. 1,100 patients are required for 90% statistical power to detect treatment-related CIMT difference of 0.025 mm. The first patient was randomized in April 2006. Conclusions The PERFORM Vascular Project will investigate terutroban’s effect on vascular structure and function in patients with a history of ischemic stroke or TIAs.

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111. Symptomatic Patients Remain at Substantial Risk of Arterial Disease Complications Before and After Endarterectomy or Stenting

Author

José M. Ferro, Lawrence K.S. Wong, Natan M. Bornstein, Carlos A. Molina, Gregory W. Albers, Peter M. Rothwell, Pierre-Jean Touboul, Philippe Gabriel Steg, Shinichiro Uchiyama, Pierre Amarenco, Leila Sissani, Eric Vicaut, Geoffrey A. Donnan, Julien Labreuche, Louis R. Caplan, Cristina Hobeanu, Philippa C. Lavallée, and Michael G. Hennerici

Subjects
Male, medicine.medical_specialty, medicine.medical_treatment, Population, Myocardial Infarction, Carotid endarterectomy, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Interquartile range, Internal medicine, Outcome Assessment, Health Care, medicine, Humans, Carotid Stenosis, Registries, Myocardial infarction, 10. No inequality, education, Stroke, Aged, Endarterectomy, Aged, 80 and over, Advanced and Specialized Nursing, Endarterectomy, Carotid, education.field_of_study, business.industry, Hazard ratio, Middle Aged, medicine.disease, Clopidogrel, 3. Good health, Surgery, Ischemic Attack, Transient, Case-Control Studies, Cardiology, Female, Stents, Neurology (clinical), Cardiology and Cardiovascular Medicine, business, Vascular Surgical Procedures, 030217 neurology & neurosurgery, Follow-Up Studies, medicine.drug
Abstract

Background and Purpose— After carotid endarterectomy (CEA) or carotid artery stenting (CAS) in patients with transient ischemic attack or minor ischemic stroke, recurrent stroke risk falls to a low rate on modern medical treatment. Methods— We used data from 4583 patients with recent transient ischemic attack or minor stroke enrolled in the TIAregistry.org to perform a nested case–control analysis to evaluate pre- and post-CEA/CAS risk. Cases were defined as patients with a CEA/CAS during the 1-year follow-up period. For each case, 2 controls with a follow-up time greater than the time from qualifying event to CEA/CAS were randomly selected, matched by age and sex. Primary outcome was defined as major vascular events (MVE, including stroke, cardiovascular death, and myocardial infarction). Results— The median delay from symptom onset of qualifying event to CEA/CAS was 11 days (interquartile range, 6–23). Overall, patients with CEA/CAS had a higher 1-year risk of MVE than other patients (14.8% versus 5.8%; adjusted hazard ratio, 2.40; 95% confidence interval, 1.61–3.60; P P =0.03). In the postprocedural period, the risk of MVE was also higher in cases than in controls (adjusted P Conclusions— Patients with CEA/CAS had a higher 12-month risk of MVE, as well as during pre- and postprocedural periods. These results suggest that patients in whom CEA/CAS is anticipated are likely to be an informative population for inclusion in studies testing new antithrombotic strategies started soon after symptom onset.

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112. Duplex scanning of normal vertebral arteries

Author

Castaigne P, Pierre-Jean Touboul, Laplane D, and Marie-Germaine Bousser

Subjects
Adult, Male, Left vertebral artery, medicine.medical_specialty, Adolescent, Vertebral artery, Hemodynamics, Duplex scanning, Reference Values, medicine.artery, Humans, Medicine, Right vertebral artery, Ultrasonics, Child, Vertebral Artery, Aged, Advanced and Specialized Nursing, business.industry, Anatomy, Middle Aged, Ostium, Vertebral artery hypoplasia, Reference values, Female, Neurology (clinical), Radiology, Cardiology and Cardiovascular Medicine, business
Abstract

Vertebral arteries were studied by Duplex scanning in 50 normal subjects. Pretransverse and C6-C5, C5-C4 intertransverse segments were visualized in all cases on both sides; segment C4-C3 was visualized in 100% of the cases on the right side and in 90% on the left; ostium was obtained in 94% of the cases on the right and in 60% on the left. The left vertebral artery was dominant in 48% of the cases while the right vertebral artery was dominant in 14%. Three vertebral arteries were hypoplasic. Duplex scanning was thus found to be an easily performed noninvasive method to study morphological and hemodynamic characteristics of vertebral arteries from their origin to the C4-C3 level.

Published
1986
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114. EARLY SPONTANEOUS FIBRINOLYSIS IS RELATED TO THE EXTENSION OF ACUTE MYOCARDIAL INFARCTION

Author

D Rousson, Marc Dechavanne, M Hanss, and Pierre-Jean Touboul

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, Internal medicine, Fibrinolysis, medicine, Cardiology, Myocardial infarction, business, medicine.disease
Abstract

The relative importance of spontaneous fibrinolysis was studied during the early stage of acute myocardial infarction (AMI). Ten consecutive male patients (52.1 ± 5.7 years old) with AMI and without haemodynamic or rythmic complications were selected. Blood samples were obtained less than 5 hours (3.4 ± 0.8 hours) after the onset of symptoms. Enzyme linked immunosorbent assay procedures were performed to quantify the D-dimer antigen (Dd-Ag) and tissue plasminogen activator antigen (tPA-Ag) plasma levels. The creatine phosphokinase (CPK) peak level was measured in serum as an index of the AMI extension. Mean ± S.D. (range) levels were respectively 368 ± 342 (118-1100) μg/1 for Dd-Ag, 12.9 ± 9.4 (4.5 - 29.1) μg/1 for tPA-Ag and 1117 ± 856 (256-2800) U/l for CPK. Coefficient correlation (r) between these parameters are given in the table.A significant linear correlation was observed between tPA-Ag and Dd-Ag. Moreover, plasma levels of these two parameters were inversely correlated to the logarithm of the CPK peak level. Thus abnormaly high tPA-Ag levels are detected in plasma from peripheric venous blood when likely marked fibrin lysis occurs and if AMI size is limited.These data suggest that impaired fibrinolysis is probably involved in the .progression of coronary occlusion during the early stage of AMI.

Published
1987
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115. Prevalence of asymptomatic internal carotid artery stenosis

Author

Pierre-Jean Touboul, M.O. Josse, Laplane D, Marie-Germaine Bousser, and J L Mas

Subjects
Continuous wave doppler, Carotid Artery Diseases, Male, medicine.medical_specialty, Epidemiology, Arterial Occlusive Diseases, Constriction, Pathologic, Asymptomatic, Duplex scanning, medicine.artery, Internal medicine, medicine, Humans, cardiovascular diseases, Internal carotid artery stenosis, Aged, Ultrasonography, Aged, 80 and over, business.industry, Middle Aged, Carotid artery.internal, cardiovascular system, Cardiology, Female, Neurology (clinical), Radiology, medicine.symptom, Internal carotid artery, business, Carotid Artery, Internal
Abstract

The prevalence of internal carotid artery stenosis was studied with continuous wave Doppler and Duplex scanning in 526 subjects aged 45-84 years of age. They were devoid of any cerebrovascular symptoms or signs and were not referred to us because of risk factors or manifestations of atherosclerosis. The prevalence of stenosis, whatever the grade, was low in both sexes aged under 65 years: 2.4% in males aged 55-64 years. It increased sharply with age, reaching 30.3% for stenosis of less than 50% and 6.1% for stenosis of greater than 50% in males aged 75-84 years. The prevalence of minimal lesion (plaque with less than 15% diameter reduction) was high: 32.1% in males aged 45-54 years and 48.5% in the 75- to 84-year age range.

Published
1987

117. Arterial wall properties in carotid artery dissection: An ultrasound study

Author

Valérie Biousse, Benoît Guillon, Pierre-Jean Touboul, M.-G. Bousser, Christophe Tzourio, and Valérie Adraï

Subjects
Adult, Male, medicine.medical_specialty, Cervical Artery, ICAD, Hemodynamics, Blood Pressure, Dissection (medical), Carotid Artery, Internal, Dissection, Carotid artery dissection, Heart Rate, medicine.artery, medicine, Humans, Common carotid artery, Ultrasonography, Internal carotid artery dissection, business.industry, Middle Aged, medicine.disease, Carotid Arteries, cardiovascular system, Female, Neurology (clinical), Radiology, Internal carotid artery, business
Abstract

Background: Cervical artery dissection is often attributed to an underlying arteriopathy related to a generalized extracellular matrix defect. Objective: The authors compared the hemodynamic and morphologic properties of the carotid artery, as assessed noninvasively by ultrasonography, in patients with spontaneous internal carotid artery dissection (ICAD) and control subjects. Method: Twenty-six patients who experienced ICAD more than 6 months before evaluation were compared with 26 controls matched for age, sex, and height. Cases and controls had ultrasound measurement of common carotid artery diameter and diameter change during the cardiac cycle, bulbar and suprabulbar internal carotid artery diameters, and common carotid artery intima–media thickness. The unaffected carotid artery in cases was compared with the carotid artery of the same side in controls. Results: Common carotid artery relative diameter change was significantly higher in cases than controls, whereas other measurements were not significantly different between the groups. In multivariate analyses, the highest tertile of common carotid artery relative diameter change was associated with the risk of ICAD (OR, 10.0; 95% CI, 1.8 to 54.2; p = 0.002) Conclusion: An underlying arteriopathy, presumably related to an extracellular matrix defect, may be present in patients with spontaneous ICAD.

118. [Dissecting aneurysm of the extracranial vertebral arteries and pregnancy]

Author

Jl, Mas, Mg, Bousser, Corone P, and Pierre-Jean Touboul

Subjects
Adult, Radiography, Aortic Dissection, Pregnancy, Pregnancy Complications, Cardiovascular, Humans, Female, Vertebral Artery
Abstract

A 32-year-old woman was at the end of her first and-until then normal-pregnancy, when she abruptly experienced a severe neck pain. Delivery was provoked two days later but a week after she suddenly developed a left lateral medullary syndrome. Angiography disclosed a severe diffuse and irregular narrowing of both vertebral arteries in their second and third segments, typical of dissecting aneurysm. The patient was treated with heparin and made a partial recovery. A second angiography nine months later showed a normal left vertebral artery while the right one was probably occluded.

119. Increased risk of atherosclerosis in women after the menopause

Author

B. Damé, Claire Bonithon-Kopp, Pierre-Jean Touboul, A. Taquet, Pierre-Yves Scarabin, and Louis Guize

Subjects
medicine.medical_specialty, business.industry, General Engineering, MEDLINE, General Medicine, Arteriosclerosis, medicine.disease, Surgery, Menopause, Increased risk, Text mining, Internal medicine, General Earth and Planetary Sciences, Medicine, Ultrasonography, business, General Environmental Science
Published
1989
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120. Impact of Lower Versus Higher LDL Cholesterol Targets on Cardiovascular Events After Ischemic Stroke in Patients With Diabetes

Author

Pierre, Amarenco, Jong S, Kim, Julien, Labreuche, Hugo, Charles, Maurice, Giroud, Byung-Chul, Lee, Philippa C, Lavallée, Marie-Hélène, Mahagne, Elena, Meseguer, Norbert, Nighoghossian, Philippe Gabriel, Steg, Éric, Vicaut, Eric, Bruckert, Jongwon, Chung, Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Université Sorbonne Paris Nord, Asan Medical Center [Seoul, South Korea] (AMC), Santé Publique : épidémiologie et qualité des soins (EA 2694), Université Lille 2 - Faculté de Médecine -Centre d'Etudes et de Recherche en Informatique Médicale [Lille] (CERIM), Physiopathologie et épidémiologie cérébro-cardiovasculaire [Dijon] (PEC2), Université de Bourgogne (UB)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Hallym University Sacred Heart Hospital [Anyang, South Korea] (HUS2H), Hôpital Pasteur [Nice] (CHU), Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hospices Civils de Lyon (HCL), Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Treat Stroke to Target Investigators, Treat Stroke to Target investigators: Pierre Amarenco, Eric Bruckert, Maurice Giroud, Jong S Kim, Julien Labreuche, Byung-Chul Lee, Marie-Hélène Mahagne, Norbert Nighoghossian, Philippe Gabriel Steg, Pierre-Jean Touboul, Eric Vicaut, Didier Leys, Yannick Béjot, Philippa Lavallée, Fernando Pico, Emmanuel Touzé, Gregory Ducrocq, Jérémy Abtan, Olivier Varenne, Charles Foix, Agnes Kemmel, Fausta Syana, Manele Ledra, Tharani Nagasara, Mervette Ledjeroud, Bahous Samia, Hafirassou Hadia, Benyoub Hazare, Ikrame El Jaghouni, Nessima Yelles, Sofia Zemouri, Salim Kerai, YunJeong In, Elena Meseguer, Philippa C Lavallée, Cristina Hobeanu, Celine Guidoux, Lucie Cabrejo, Bertrand Lapergue, Candice Sabben, Jaime Gonzalez-Valcarcel, Ricardo Rigual, Gaia Sirimarco, Anna Martin-Bechet, Elena Viedma, Ioan Avram, Yves Samson, Charlotte Rosso, Sophie Crozier, Sara Leder, Anne Léger, Sandrine Deltour, Gurkan Mutlu, Marion Yger, Chiara Zavanone, Flore Baronnet, Christine Pires, Bertrand Lapergue, Adrien Wang, Serge Evrard, Maya Tchikviladze, Frédéric Bourdain, Delphine Lopez, Fernando Pico, Laetitia Bayon de la Tour, Marie-Laure Chadenat, Duc Long Duong, Solène Genty, Catherine Hirel, Chantal Nifle, Jérôme Servan, Daniela Stanciu, Veronica Sudacevschi, Mélissa Tir, Anne-Cécile Troussière, Jennifer Yeung, Anne-Céline Zeghoudi, Ikram Tidafi-Bayou, Sylvain Lachaud, Tae-Hee Cho, Laura Mechtouff, Thomas Ritzenthaller, Laurent Derex, Carlo Albanesi, Elodie Ong, Amandine Benoit, Nadia Berhoune, Sandra Felix, Maud Esteban-Mader, Igor Sibon, Annabelle Kazadi, François Rouanet, Pauline Renou, Sabrina Debruxelles, Mathilde Poli, Sharmila Sagnier, Jean-Louis Mas, Valérie Domigo, Catherine Lamy, Eric Bodiguel, Jérôme Grimaud, Valentin Bohotin, Michael Obadia, Erwan Morvan, Gilles Rodier, Wilfried Vadot, Hilde Hénon, Charlotte Cordonnier, Frédéric Dumont, Marie Bodenant, Christian Lucas, Solène Moulin, Nelly Dequatre, Sonia Alamowitch, Jean-Paul Muresan, Thomas Drouet, Magalie Gallea, Marie-Amélie Dalloz, Stephen Delorme, Marion Yger, Yannick Béjot, Philippe Loisel, Carine Bonnin, Virginie Bernigal, Guy Victor Osseby, Marie Hervieu-Bègue Marsac, Pierre Garnier, Sandrine Accassat, Magali Epinat, Jérôme Varvat, Doïna Marinescu, Aude Triquenot-Bagan, Ozlem Ozkul-Wermester, Frédéric Philippeau, Angel Olaru, Anne Vieillart, Annie Lannuzel, Alice Demoly, Valérie Wolff, Mihaela Diaconu, Marc Bataillard, Francisco Macian Montoro, Frédéric Faugeras, Laeticia Gimenez, Françoise Abdallah-Lebeau, Serge Timsit, Irina Viakhireva-Dovganyuk, Anne Tirel-Badets, François-Mathias Merrien, Philippe Goas, François Rouhart, Aurore Jourdain, Benoit Guillon, Fanny Hérissson, Mathieu Sevin-Allouet, Nathalie Nasr, Jean-Marc Olivot, Alderic Lecluse, Guillaume Marc, Marie Christine Hamon, Emmanuel Touzé, Vincent de la Sayette, Marion Apoil, Li Lin, Julien Cogez, Sophie Guettier, Olivier Godefroy, Jean-Marc Bugnicourt, Grégory Taurin, Marc Mérienne, Julien Gere, Anne-Marie Chessak, Tarik Habet, Anna Ferrier, Nathalie Bourgois, Dominique Minier, Marie Caillier-Minier, Fabienne Contégal-Callier, Philippe Vion, Yvan Vaschalde, Mohammed El Amrani, Emilie Xxx, Mathieu Zuber, Marie Bruandet, Claire Join-Lambert, Pierre-Yves Garcia, Isabelle Serre, Jean-Marc Faucheux, Fatia Radji, Elena Leca-Radu, Thomas Debroucker, Rodica Cumurcuc, Serkan Cakmak, Stéphane Peysson, Emmanuel Ellie, Patricia Bernady, Thierry Moulin, Paola Montiel, Eugeniu Revenco, Pierre Decavel, Elisabeth Medeiros, Myriam Bouveret, Pierre Louchart, Jean-Philippe Neau, Xavier Vandamme, Isabelle Meresse, Xxx Stantescu, Canan Ozsancak, Katell Beauvais, Pascal Auzou, Joséphine Amevigbe, Francis Vuillemet, Marie-Hélène Dugay-Arentz, Gabriela Carelli, Mikel Martinez, Marcel Maillet-Vioud, Jean-Pierre Escaillas, Stéphane Chapuis, Jean Tardy, Eric Manchon, Olivier Varnet, Yong-Jae Kim, Yoonkyung Chang, Tae-Jin Song, Jong Sung Kim, Jung-Hoon Han, Kyung Chul Noh, Eun-Jae Lee, Dong-Wha Kang, Sun Uck Kwon, Boseoung Kwon, Seongho Park, Dongwhane Lee, Hyuk Sung Kwon, Daeun Jeong, MinHwan Lee, Joonggoo Kim, Hanbin Lee, Hyo Jung Nam, Sang Hun Lee, Bum Joon Kim, Jae-Kwan Cha, DaeHyun Kim, Rae Young Kim, Sang Wuk Sohn, Dong-Hyun Shim, Hyungjin Lee, Hyun-Wook Nah, Sang Min Sung, Kyung Bok Lee, Jeong Yoon Lee, Jee Eun Yoon, Eung-Gyu Kim, Jung Hwa Seo, Yong-Won Kim, Yangha Hwang, Man Seok Park, Joon-Tae Kim, Kang-Ho Choi, Hyo Suk Nam, Ji Hoe Heo, Young Dae Kim, In Gun Hwang, Hyung Jong Park, Kyoung Sub Kim, Jang Hyun Baek, Dong Beom Song, Joon Sang Yoo, Jong-Moo Park, Ohyun Kwon, Woong-Woo Lee, Jung-Ju Lee, Kyusik Kang, Byung Kun Kim, Byung-Chul Lee, Jae-Sung Lim, Mi Sun Oh, Kyung-Ho Yu, Bora Hong, Mihoon Jang, Seyoung Jang, Jung Eun Jin, Jei Kim, Hye Seon Jeong, Keun Sik Hong, Hong Kyun Park, Yong Jin Cho, Oh Young Bang, Woo-Keun Seo, Jongwon Chung., Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Faculté de Médecine Henri Warembourg - Université de Lille-Centre d'Etudes et de Recherche en Informatique Médicale [Lille] (CERIM), and CarMeN, laboratoire

Subjects
Male, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, [SDV]Life Sciences [q-bio], Hypercholesterolemia, Myocardial Infarction, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Text mining, Internal medicine, Diabetes mellitus, Internal Medicine, Medicine, Humans, In patient, cardiovascular diseases, Aged, Ischemic Stroke, Ldl cholesterol, business.industry, Cholesterol, LDL, Middle Aged, medicine.disease, Ezetimibe, 3. Good health, [SDV] Life Sciences [q-bio], Treatment Outcome, Diabetes Mellitus, Type 2, Ischemic stroke, Cardiology, lipids (amino acids, peptides, and proteins), Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, business, 030217 neurology & neurosurgery
Abstract

International audience; After an ischemic stroke with evidence of atherosclerosis, lipid-lowering treatment with a target LDL cholesterol of

Published
2021
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121. A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke

Author

Amarenco P, Kim J, Labreuche J, Charles H, Abtan J, Bejot Y, Cabrejo L, Cha J, Ducrocq G, Giroud M, Guidoux C, Hobeanu C, Kim Y, Lapergue B, Lavallee P, Lee B, Lee K, Leys D, Mahagne M, Meseguer E, Nighoghossian N, Pico F, Samson Y, Sibon I, Steg P, Sung S, Touboul P, Touze E, Varenne O, Vicaut E, Yelles N, Bruckert E, Treat Stroke Target Investigators, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Asan Medical Center [Seoul], University of Ulsan, Santé Publique : épidémiologie et qualité des soins (EA 2694), Faculté de Médecine Henri Warembourg - Université de Lille-Centre d'Etudes et de Recherche en Informatique Médicale [Lille] (CERIM), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Université de Bourgogne (UB), Service de neurologie [Rouen], CHU Rouen, Normandie Université (NU)-Normandie Université (NU), Catholic University of Korea, Hôpital Foch [Suresnes], Hallym University Sacred Heart Hospital [Anyang, South Korea] (HUS2H), Soonchunhyang University [Asan], CHU Lille, Hôpital Pasteur [Nice] (CHU), Hospices Civils de Lyon (HCL), Centre Hospitalier de Versailles André Mignot (CHV), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Sorbonne Université (SU), Hôpital Pellegrin, CHU Bordeaux [Bordeaux]-Groupe hospitalier Pellegrin, Pusan National University Hospital, Physiopathologie et imagerie des troubles neurologiques (PhIND), Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Neurologie [CHU Caen], Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), GIP Cyceron (Cyceron), Normandie Université (NU)-Normandie Université (NU)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de Cardiologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord, Hôpitaux Universitaire Saint-Louis, Lariboisière, Fernand-Widal, Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP], Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), CHU Amiens-Picardie, and Treat Stroke to Target Investigators: Pierre Amarenco, Eric Bruckert, Maurice Giroud, Jong S Kim, Julien Labreuche, Byung-Chul Lee, Marie-Hélène Mahagne, Norbert Nighoghossian, Philippe Gabriel Steg, Pierre-Jean Touboul, Eric Vicaut, Didier Leys, Philippa Lavallée, Gregory Ducrocq, Jérémy Abtan, Olivier Varenne, Agnes Kemmel, Fausta Syana, Manele Ledra, Tharani Nagasara, Mervette Ledjeroud, Bahous Samia, Hafirassou Hadia, Benyoub Hazare, Ikrame El Jaghouni, Nessima Yelles, Sofia Zemouri, Mervette Ladjeroud, Salim Kerai, YunJeong In, Elena Meseguer, Philippa C Lavallée, Cristina Hobeanu, Celine Guidoux, Lucie Cabrejo, Jaime Gonzalez-Valcarcel, Ricardo Rigual, Gaia Sirimarco, Anna Martin-Bechet, Elena Viedma, Ioan Avram, Yves Samson, Charlotte Rosso, Sophie Crozier, Sara Leder, Anne Léger, Sandrine Deltour, Chiara Zavanone, Flore Baronnet, Christine Pires, Bertrand Lapergue, Adrien Wang, Serge Evrard, Maya Tchikviladze, Frédéric Bourdain, Delphine Lopez, Fernando Pico, Laetitia Bayon de la Tour, Marie-Laure Chadenat, Duc Long Duong, Solène Genty, Catherine Hirel, Gurkan Mutlu, Chantal Nifle, Jérôme Servan, Daniela Stanciu, Veronica Sudacevschi, Mélissa Tir, Anne-Cécile Troussière, Jennifer Yeung, Anne-Céline Zeghoudi, Ikram Tidafi-Bayou, Sylvain Lachaud, Tae-Hee Cho, Laura Mechtouff, Thomas Ritzenthaller, Laurent Derex, Carlo Albanesi, Elodie Ong, Amandine Benoit, Nadia Berhoune, Sandra Felix, Maud Esteban-Mader, Igor Sibon, Annabelle Kazadi, François Rouanet, Pauline Renou, Sabrina Debruxelles, Mathilde Poli, Sharmila Sagnier, Jean-Louis Mas, Valérie Domigo, Catherine Lamy, Eric Bodiguel, Jérôme Grimaud, Valentin Bohotin, Michael Obadia, Candice Sabben, Erwan Morvan, Gilles Rodier, Wilfried Vadot, Hilde Hénon, Charlotte Cordonnier, Frédéric Dumont, Marie Bodenant, Christian Lucas, Solène Moulin, Nelly Dequatre, Sonia Alamowitch, Jean-Paul Muresan, Thomas Drouet, Magalie Gallea, Marie-Amélie Dalloz, Stephen Delorme, Marion Yger, Yannick Béjot, Philippe Loisel, Carine Bonnin, Virginie Bernigal, Guy Victor Osseby, Marie Hervieu-BègueMarsac, Pierre Garnier, Sandrine Accassat, Magali Epinat, Jérôme Varvat, Doïna Marinescu, Aude Triquenot-Bagan, Ozlem Ozkul-Wermester, Frédéric Philippeau, Angel Olaru, Anne Vieillart, Annie Lannuzel, Alice Demoly, Valérie Wolff, Mihaela Diaconu, Francisco Macian Montoro, Frédéric Faugeras, Laeticia Gimenez, Françoise Abdallah-Lebeau, Serge Timsit, Irina Viakhireva-Dovganyuk, Anne Tirel-Badets, François-Mathias Merrien, Philippe Goas, François Rouhart, Aurore Jourdain, Benoit Guillon, Fanny Hérissson, Mathieu Sevin-Allouet, Nathalie Nasr, Jean-Marc Olivot, Alderic Lecluse, Guillaume Marc, Emmanuel Touzé, Vincent de la Sayette, Marion Apoil, Li Lin, Julien Cogez, Sophie Guettier, Olivier Godefroy, Chantal Lamy, Jean-Marc Bugnicourt, Grégory Taurin, Marc Mérienne, Julien Gere, Anne-Marie Chessak, Tarik Habet, Anna Ferrier, Nathalie Bourgois, Dominique Minier, Marie Caillier-Minier, Fabienne Contégal-Callier, Philippe Vion, Yvan Vaschalde, Mohammed El Amrani, Mathieu Zuber, Marie Bruandet, Claire Join-Lambert, Pierre-Yves Garcia, Isabelle Serre, Jean-Marc Faucheux, Fatia Radji, Elena Leca-Radu, Thomas Debroucker, Rodica Cumurcuc, Serkan Cakmak, Stéphane Peysson, Emmanuel Ellie, Patricia Bernady, Thierry Moulin, Paola Montiel, Eugeniu Revenco, Pierre Decavel, Elisabeth Medeiros, Myriam Bouveret, Pierre Louchart, Claudia Vaduva, Grégory Couvreur, Eric Sartori, Adam Amer Alnajar-Carpentier, Michèle Levasseur, Pierre Louchart, Jean-Philippe Neau, Xavier Vandamme, Isabelle Meresse, Marc Bataillard, Canan Ozsancak, Katell Beauvais, Pascal Auzou, Joséphine Amevigbe, Francis Vuillemet, Marie-Hélène Dugay-Arentz, Gabriela Carelli, Mikel Martinez, Marcel Maillet-Vioud, Jean-Pierre Escaillas, Stéphane Chapuis, Jean Tardy, Eric Manchon, Olivier Varnet, Yong-Jae Kim, Yoonkyung Chang, Tae-Jin Song, Jong Sung Kim, Jung-Hoon Han, Kyung Chul Noh, Eun-Jae Lee, Dong-Wha Kang, Sun Uck Kwon, Boseoung Kwon, Seongho Park, Dongwhane Lee, Hyuk Sung Kwon, Daeun Jeong, MinHwan Lee, Joonggoo Kim, Hanbin Lee, Hyo Jung Nam, Sang Hun Lee, Bum Joon Kim, Jae-Kwan Cha, DaeHyun Kim, Rae Young Kim, Sang Wuk Sohn, Dong-Hyun Shim, Hyungjin Lee, Hyun-Wook Nah, Sang Min Sung, Kyung Bok Lee, Jeong Yoon Lee, Jee Eun Yoon, Eung-Gyu Kim, Jung Hwa Seo, Yong-Won Kim, Yangha Hwang, Man Seok Park, Joon-Tae Kim, Kang-Ho Choi, Hyo Suk Nam, Ji Hoe Heo, Young Dae Kim, In Gun Hwang, Hyung Jong Park, Kyoung Sub Kim, Jang Hyun Baek, Dong Beom Song, Joon Sang Yoo, Jong-Moo Park, Ohyun Kwon, Woong-Woo Lee, Jung-Ju Lee, Kyusik Kang, Byung Kun Kim, Jae-Sung Lim, Mi Sun Oh, Kyung-Ho Yu, Bora Hong, Mihoon Jang, Seyoung Jang, Jung Eun Jin, Jei Kim, Hye Seon Jeong, Keun Sik Hong, Hong Kyun Park, Yong Jin Cho, Oh Young Bang, Woo-Keun Seo, Jongwon Chung

Subjects
Adult, Male, medicine.medical_specialty, Statin, medicine.drug_class, [SDV]Life Sciences [q-bio], MEDLINE, Kaplan-Meier Estimate, 030204 cardiovascular system & hematology, Brain Ischemia, law.invention, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Text mining, Pharmacotherapy, Randomized controlled trial, law, Internal medicine, Humans, Medicine, cardiovascular diseases, 030212 general & internal medicine, Aged, Intention-to-treat analysis, business.industry, Cholesterol, Anticholesteremic Agents, Cholesterol, LDL, General Medicine, Middle Aged, Atherosclerosis, Ezetimibe, Intention to Treat Analysis, Stroke, chemistry, Cardiovascular Diseases, Ischemic Attack, Transient, Ischemic stroke, Drug Therapy, Combination, Female, lipids (amino acids, peptides, and proteins), Hydroxymethylglutaryl-CoA Reductase Inhibitors, business
Abstract

International audience; 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.).

Published
2020
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122. Treat stroke to target trial design: First trial comparing two LDL targets in patients with atherothrombotic strokes.

Author

Amarenco P, Kim JS, Labreuche J, Giroud M, Lee BC, Mahagne MH, Nighoghossian N, Simon T, Steg PG, Touboul PJ, Vicaut E, Yelles N, and Bruckert E

Abstract

Background: In patients with non-cardio-embolic stroke, atorvastatin 80 mg/day reduced the relative risk of recurrent stroke by 16%, and a post hoc analysis showed that achieving an LDL-c of less than 70 mg/dL reduced the relative risk by 28% as compared to an on-treatment LDL of 100 mg/dL or more. Current guidelines from the French drug agency recommend treating with a statin after an ischaemic stroke to a target of less than 100 mg/dL, but no study directly tested LDL-c targets. The Treat Stroke to Target (TST) trial will compare the efficacy of achieving an LDL-c of less than 70 mg/dL versus an achieved LDL-c of 100 ± 10 mg/dL for secondary prevention in patients with recent ischaemic stroke of atherosclerotic origin.Main hypothesis: An achieved on-treatment LDL-c of less than 70 mg/dL will reduce by 25% the risk of recurrent ischaemic stroke, myocardial infarction, urgent coronary or carotid revascularisation following new symptoms requiring hospitalisation, and vascular death compared with on-treatment LDL-c of 100 ± 10 mg/dL., Design: Patients are randomised to either LDL-c levels, and the investigator who is not blinded can use the lipid-lowering agent of his/her choice available on the market (including statins and ezetimibe), in order to achieve the assigned LDL-c level. To be eligible for enrolment, patients have a recent ischaemic stroke or TIA of atherosclerotic origin with at least one arterial stenosis of a cerebral artery, enrolled between acute phase of the qualifying stroke (once the neurological deficit is stabilised) and three months. The initial planned sample size of 3760 participants followed three years was amended to allow follow-up of all enrolled patients until 385 primary efficacy outcome events have occurred, and no later than 31 December 2019. Patients will be recruited in 76 sites in two countries (France and South Korea) between March 2010 and December 2018 (last included patient followed up to one year). Safety outcomes will include haemorrhagic strokes and new onset diabetes. All primary endpoints will be adjudicated by an endpoint committee, blinded to the assigned LDL-c level. Two sub-studies assess (1) the relative effect of assigned LDL-c levels on occurrence of new atherosclerotic plaque as detected by carotid ultrasound during follow-up, using M'ATH software for repositioning and (2) the genetic and biomarker drivers of recurrent primary endpoints according to assigned LDL-c lowering arm, in atherosclerotic strokes., Summary: The TST trial is evaluating the benefits of achieving an LDL-c less than 70 mg/dL for secondary stroke prevention in ischaemic stroke patients of atherosclerotic origin. Main results are anticipated in 2020 or earlier (ClinicalTrials.gov NCT01252875)., (© European Stroke Organisation 2019.)

Published
2019
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