Relative and cumulative effects of lipid and blood pressure control in the stroke prevention by aggressive reduction in cholesterol levels trial

• Verfasst von: Amarenco, Pierre [VerfasserIn]
• Verfasst von: Goldstein, Larry B. [VerfasserIn]
• Verfasst von: Messig, Michael [VerfasserIn]
• Verfasst von: O'Neill, Blair J. [VerfasserIn]
• Verfasst von: Callahan, Alfred [VerfasserIn]
• Verfasst von: Sillesen, Henrik [VerfasserIn]
• Verfasst von: Hennerici, Michael G. [VerfasserIn]
• Verfasst von: Zivin, Justin A. [VerfasserIn]
• Verfasst von: Welch, K. M. A. [VerfasserIn]
• Titel: Relative and cumulative effects of lipid and blood pressure control in the stroke prevention by aggressive reduction in cholesterol levels trial
• Verf.angabe: 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, and on behalf of the SPARCL Investigators
• E-Jahr: 2009
• Jahr: 21 May 2009
• Umfang: 7 S.
• Fussnoten: Gesehen am 07.04.2022
• Titel Quelle: Enthalten in: Stroke
• Ort Quelle: New York, NY : Association, 1970
• Jahr Quelle: 2009
• Band/Heft Quelle: 40(2009), 7, Seite 2486-2492
• ISSN Quelle: 1524-4628
• DOI: doi:10.1161/STROKEAHA.108.546135
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Adult
• Sach-SW: Aged
• Sach-SW: Aged, 80 and over
• Sach-SW: Anticholesteremic Agents
• Sach-SW: Atorvastatin
• Sach-SW: Blood Pressure
• Sach-SW: Cholesterol
• Sach-SW: Cholesterol, HDL
• Sach-SW: Cholesterol, LDL
• Sach-SW: Female
• Sach-SW: Heptanoic Acids
• Sach-SW: Humans
• Sach-SW: Hypercholesterolemia
• Sach-SW: Ischemic Attack, Transient
• Sach-SW: Male
• Sach-SW: Middle Aged
• Sach-SW: Pyrroles
• Sach-SW: Risk Factors
• Sach-SW: Secondary Prevention
• Sach-SW: Stroke
• Sach-SW: Treatment Outcome
• Sach-SW: Triglycerides
• Sach-SW: Young Adult
• K10plus-PPN: 1798127776

Abstract

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.