Relationship between risk factor control and vascular events in the SAMMPRIS trial
Relationship between risk factor control and vascular events in the SAMMPRIS trial
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DOI：
10.1212/wnl.0000000000003534
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发表时间：
2017-01-24
期刊：
影响因子：
9.9
通讯作者：
Chimowitz, Marc I.
中科院分区：
文献类型：
--
作者：
Turan, Tanya N.;Nizam, Azhar;Chimowitz, Marc I.
目的：支架植入和积极的医疗管理预防颅内狭窄患者复发性卒中（SAMMPRIS）研究是第一项包括方案驱动的多种风险因素强化管理的卒中预防试验。在这个预先规定的分析，我们的目的是调查在后续的危险因素控制和结果的患者在医疗手臂SAMMPRIS.Methods：数据从SAMMPRIS参与者在医疗手臂（n = 227）进行了分析。在基线、第30天、第4个月记录风险因素，然后每4个月记录一次，平均随访32个月。对于每名患者，所有风险因素测量值均取平均值，并分为目标内或目标外。收缩压和体力活动超出目标的参与者，以及平均低密度脂蛋白胆固醇和非高密度脂蛋白较高的参与者，更有可能复发血管事件（中风、心肌梗死或血管性死亡）与风险因素控制良好的患者相比。在多变量分析中，更多的体力活动减少复发性中风，心肌梗死，或血管性死亡的可能性（优势比0.6，置信区间0.4-0.8）。结论：提高血压，胆固醇，和体力活动不足，应积极治疗颅内动脉粥样硬化患者，以防止未来的血管事件。在SAMMPRIS研究中，身体活动是医疗组良好结局的最强预测因子，但在卒中预防试验中没有受到关注。
Objective: The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocoldriven intensive management of multiple risk factors. In this prespecified analysis, we aimed to investigate the relationship between risk factor control during follow-up and outcome of patients in the medical arm of SAMMPRIS.Methods: Data from SAMMPRIS participants in the medical arm (n = 227) were analyzed. Risk factors were recorded at baseline, 30 days, 4 months, and then every 4 months for a mean followup of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target.Results: Participants who were out of target for systolic blood pressure and physical activity, as well as those with higher mean low-density lipoprotein cholesterol and non-high-density lipoprotein, were more likely to have a recurrent vascular event (stroke, myocardial infarction, or vascular death) at 3 years compared to those who had good risk factor control. In the multivariable analysis, greater physical activity decreased the likelihood of a recurrent stroke, myocardial infarction, or vascular death (odds ratio 0.6, confidence interval 0.4-0.8).Conclusions: Raised blood pressure, cholesterol, and physical inactivity should be aggressively treated in patients with intracranial atherosclerosis to prevent future vascular events. Physical activity, which has not received attention in stroke prevention trials, was the strongest predictor of a good outcome in the medical arm in SAMMPRIS.