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缺血性脑卒中后严控LDL胆固醇水平可降低心血管事件风险
作者:小柯机器人 发布时间:2019/11/19 15:55:00

法国巴黎比查特医院Pierre Amarenco团队的一项最新研究,比较了缺血性脑卒中后低密度脂蛋白胆固醇两种控制目标的结果。这一研究成果2019年11月18日发表在国际顶尖学术期刊《新英格兰医学杂志》上。

短暂性脑缺血发作(TIA)和动脉粥样硬化性缺血性卒中后,一般建议对患者采用他汀类药物进行强化降脂治疗。而卒中后为降低心血管事件的发生率,低密度脂蛋白(LDL)胆固醇控制的目标水平仍有待研究。

这项在法国和韩国进行的平行组试验中,研究组招募了2860名3个月内发生缺血性卒中或15天内发生TIA的患者,将其随机分组,其中1430名将LDL胆固醇水平控制在70 mg/dL以下(低目标组),1430名控制在90-110 mg/dL(高目标组)。所有患者都有脑血管或冠状动脉硬化的迹象,并接受他汀类药物或伊泽替米治疗。

两组患者基线时的LDL胆固醇水平为135 mg/dL,平均随访3.5年后,低目标组为65 mg/dL,高目标组为96 mg/dL。低目标组中有121例(8.5%)患者发生缺血性卒中、心肌梗死、致紧急冠脉或颈动脉血管重建的新症状或心血管原因死亡,高目标组中为156例(10.9%),差异显著。两组患者中颅内出血和新发糖尿病的发生率无显著差异。

总之,当缺血性中风或TIA并伴有动脉粥样硬化迹象时,将LDL胆固醇水平控制在70 mg/dL以下,与90-110 mg/dL相比,可显著降低心血管事件的风险。

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

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home