| Relative and cumulative effects of lipid and blood pressure control in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels trial. | |
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MedLine Citation:
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PMID: 19461031 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: The relative contributions of on-treatment low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), triglycerides, and blood pressure (BP) control on the risk of recurrent stroke or major cardiovascular events in patients with stroke is not well defined. METHODS: We randomized 4731 patients with recent stroke or transient ischemic attack and no known coronary heart disease to atorvastatin 80 mg per day or placebo. RESULTS: After 4.9 years, at each level of LDL-C reduction, subjects with HDL-C value above the median or systolic BP below the median had greater reductions in stroke and major cardiovascular events and those with a reduction in triglycerides above the median or diastolic BP below the median showed similar trends. There were no statistical interactions between on-treatment LDL-C, HDL-C, triglycerides, and BP values. In a further exploratory analysis, optimal control was defined as LDL-C <70 mg per deciliter, HDL-C >50 mg per deciliter, triglycerides <150 mg per deciliter, and SBP/DBP <120/80 mm Hg. The risk of stroke decreased with as the level of control increased (hazard ratio [95% confidence interval] 0.98 [0.76 to 1.27], 0.78 [0.61 to 0.99], 0.62 [0.46 to 0.84], and 0.35 [0.13 to 0.96]) for those achieving optimal control of 1, 2, 3, or 4 factors as compared to none, respectively. Results were similar for major cardiovascular events. CONCLUSIONS: We found a cumulative effect of achieving optimal levels of LDL-C, HDL-C, triglycerides, and BP on the risk of recurrent stroke and major cardiovascular events. The protective effect of having a higher HDL-C was maintained at low levels of LDL-C. |
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Authors:
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Pierre Amarenco; Larry B Goldstein; Michael Messig; Blair J O'Neill; Alfred Callahan; Henrik Sillesen; Michael G Hennerici; Justin A Zivin; K M A Welch; |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't Date: 2009-05-21 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 40 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2009 Jul |
Date Detail:
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Created Date: 2009-06-30 Completed Date: 2009-07-27 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 2486-92 Citation Subset: IM |
Affiliation:
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INSERM U-698, Denis Diderot University-Paris VII, Department of Neurology, Bichat University Hospital, Paris, France. pierre.amarenco@bch.aphp.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Anticholesteremic Agents / therapeutic use* Blood Pressure / physiology* Cholesterol / blood* Cholesterol, HDL / blood Cholesterol, LDL / blood Female Heptanoic Acids / therapeutic use* Humans Hypercholesterolemia / blood, drug therapy*, physiopathology Ischemic Attack, Transient / epidemiology, pathology, prevention & control Male Middle Aged Pyrroles / therapeutic use* Recurrence / prevention & control Risk Factors Stroke / epidemiology, physiopathology, prevention & control* Treatment Outcome Triglycerides / blood Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Heptanoic Acids; 0/Pyrroles; 0/Triglycerides; 110862-48-1/atorvastatin; 57-88-5/Cholesterol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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