No ICH risk in stroke patients with Target LDL cholesterol below 70 mg/dL: Study
France: A new analysis of the TST trial reveals that targeting an LDL cholesterol of below 70 mg/dL versus 100 mg/dL in atherosclerotic ischemic stroke patients did not significantly increase intracranial hemorrhage (ICH) risk. The recent data, published in Stroke, the journal of the American Heart Association (AHA), provides further reassurance about lowering LDL cholesterol and the risk for ICH in stroke patients.
Statins, although, are effective in the secondary prevention of ischemic stroke. Also, they are associated with an increased ICH risk in certain conditions. In the TST trial (Treat Stroke to Target), Pierre Amarenco, Department of Neurology and Stroke Center, Bichat Hospital, Paris, France, and colleagues prespecified an exploration of the predictors of incident ICH.
The study included patients with ischemic stroke in the previous 3 months or transient ischemic attack within the previous 15 days and evidence of cerebrovascular or coronary artery atherosclerosis. They were randomly assigned in a ratio of 1:1 to a target LDL (low-density lipoprotein) cholesterol of <70 mg/dL or 100±10 mg/dL, using statin or ezetimibe.
Based on the study, the researchers found the following:
· Among 2860 patients enrolled, 31 incident ICH occurred over a median follow-up of 3 years (18 and 13 in the lower and higher target group, 3.21/1000 patient-years and 2.32/1000 patient-years, respectively).
· While there were no baseline predictors of ICH, uncontrolled hypertension (HR, 2.51) and being on anticoagulant (HR, 2.36) during the trial were significant predictors.
· On-treatment low LDL cholesterol was not a predictor of ICH.
"Targeting an LDL cholesterol of <70 mg/dL versus 100±10 mg/dL in patients with atherosclerotic ischemic stroke nonsignificantly increased ICH risk," wrote the authors. "Incident ICHs were not related to low LDL cholesterol. Uncontrolled hypertension and anticoagulant therapy were associated with ICH which has important clinical implications."
Reference:
The study titled, "Intracranial Hemorrhage in the TST Trial," was published in the journal Stroke.
