Amarenco P等，《循环》2020年6月29日

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摘要

背景：治疗卒中靶向（TST）试验显示，靶向低密度脂蛋白胆固醇（LDL-C）浓度<70mg/dL，有助于降低2860例缺血性脑卒中合并脑血管粥样硬化性狭窄患者发生主要心血管事件的风险。对颈动脉粥样硬化演变的影响尚不清楚。方法：TST-PLUS（治疗卒中靶向斑块超声研究）包括201例LDL-C浓度<70mg/dL的患者和212名目标为100±10mg/dL的患者。为了达到这些目标，研究人员使用他汀类药物和他们选择的剂量，并根据需要添加依泽替米韦。超声检查人员认证后，在基线检查时，在2年、3年和5年使用M'athm软件进行颈动脉超声检查。所有图像直接从颈动脉超声设备上传到医学技术智能（IMTTM）数据库。中心实验室对随机分组的两条颈总动脉的内膜中层厚度进行了所有的离线测量。主要结果是新诊断的颈动脉分叉处或颈内动脉起源的动脉粥样硬化斑块，采用曼海姆共识定义，以及组间比较颈总动脉内膜中层厚度（CCA-IMT）的变化。结果：中位随访3.1年后，低靶组的LDL-C浓度为64mg/dL（1.64mmol/L），高靶组为106mg/dL（2.72mmol/L）。与高目标组相比，低目标组患者的新诊断颈动脉斑块的发生率相似：46/201（5年率，26.1%）和45/212（5年率，29.7%）。较高目标组的CCA-IMT变化为-2.69µm（95%CI，-6.55-1.18），低目标组为-10.53µm（95%CI，-14.21-6.85），组间绝对差异为-7.84µm[95%CI，-13.18 to-2.51]，P=0.004）。结论：在缺血性中风和动脉粥样硬化患者中，<70mg/dL（1.8mmol/L）的LDL-C靶点并不能减少新颈动脉斑块的发生率，但与90-110mg/dL的LDL-C靶点相比，颈动脉粥样硬化的消退明显更大。临床试验注册：网址：https://clinicaltrials.gov唯一标识符：NCT01252875。

Carotid Atherosclerosis Evolution when Targeting a Low-Density Lipoprotein Cholesterol Concentration < 70 mg/dL after an Ischemic Stroke of Atherosclerotic Origin.
Amarenco P,et al Circulation 2020 Jun 29
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Abstract 翻译

Background: The Treat Stroke to Target (TST) trial showed the benefit of targeting a low-density lipoprotein cholesterol (LDL-C) concentration of <70 mg/dL, in term of reducing the risk of major cardiovascular events in 2860 patients with ischemic stroke with atherosclerotic stenosis of cerebral vasculature. The impact on carotid atherosclerosis evolution is not known. Methods: TST-PLUS (Treat Stroke to Target-PLaque Ultrasound Study) included 201 patients assigned to a LDL-C concentration of <70 mg/dL and 212 patients assigned to a target of 100±10 mg/dL. To achieve these goals, investigators used the statin and dosage of their choice and added ezetimibe as needed. After certification of ultra-sonographers, carotid ultrasound examinations were performed using M'ATHTM software at baseline, and at 2, 3, and 5 years. All images were up-loaded to the Intelligence in Medical Technology (IMTTM) 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 <70 mg/dL (1.8 mmol/L) did not reduce the incidence of new carotid plaques but produced significantly greater regression of carotid atherosclerosis than an LDL-C target of 90 to 110 mg/dL. Clinical Trial Registration: URL: https://clinicaltrials.gov Unique Identifier: NCT01252875.