Management of vascular risk factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).
Management of vascular risk factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).
复制标题
DOI：
10.1161/jaha.114.001180
复制
发表时间：
2014-11-26
影响因子：
5.4
通讯作者：
Brott TG
中科院分区：
文献类型：
--
作者：
Meschia JF;Voeks JH;Leimgruber PP;Mantese VA;Timaran CH;Chiu D;Demaerschalk BM;Howard VJ;Hughes SE;Longbottom M;Howard AG;Brott TG
颈动脉血运重建动脉内膜切除术与支架植入术试验（CREST）是一项在症状性和无症状性颈动脉疾病患者中比较支架植入术与动脉内膜切除术的多中心随机试验。本研究评估了血管危险因素的管理。由患者的医生提供管理，由当地研究中心收集一年两次的监测结果。治疗目标为低密度脂蛋白、胆固醇<100 mg/dL、收缩压<140 mm Hg、空腹血糖<126 mg/dL和非吸烟状态。最佳控制被定义为同时实现所有4个目标。使用广义估计方程比较基线时的风险因素与长达48个月的计划随访访视中观察到的风险因素。在2210的分析队列中，与基线相比，在所有随访访视的风险因素中观察到风险因素控制的显著改善。48个月时，低密度脂蛋白胆固醇目标的实现率从59.1%提高到73.6%收缩压达标率由51.6%提高到65.1%（P<0.001）血糖达标率从74.9%提高到80.7%（P=0.0101），不吸烟率从74.4%提高到80.9%（P<0.0001）。最佳风险因素控制的百分比也显著提高，从16.7%提高到36.2%（P<0.001），但近2/3的研究参与者在研究期间没有达到最佳控制。在CREST中，基于临床试验机构的风险因素控制在前6个月和长期内显著改善，但通常不理想。在未来的颈动脉血运重建试验中应考虑强化医疗管理。URL：ClinicalTrials.gov.唯一标识符：NCT 00004732。
The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) is a multicenter randomized trial of stenting versus endarterectomy in patients with symptomatic and asymptomatic carotid disease. This study assesses management of vascular risk factors. Management was provided by the patient's physician, with biannual monitoring results collected by the local site. Therapeutic targets were low‐density lipoprotein, cholesterol <100 mg/dL, systolic blood pressure <140 mm Hg, fasting blood glucose <126 mg/dL, and nonsmoking status. Optimal control was defined as achieving all 4 goals concurrently. Generalized estimating equations were used to compare risk factors at baseline with those observed in scheduled follow‐up visits for up to 48 months. In the analysis cohort of 2210, significant improvements in risk‐factor control were observed across risk factors for all follow‐up visits compared with baseline. At 48 months, achievement of the low‐density lipoprotein cholesterol goal improved from 59.1% to 73.6% (P<0.001), achievement of the systolic blood pressure goal improved from 51.6% to 65.1% (P<0.001), achievement of the glucose goal improved from 74.9% to 80.7% (P=0.0101), and nonsmoking improved from 74.4% to 80.9% (P<0.0001). The percentage with optimal risk‐factor control also improved significantly, from 16.7% to 36.2% (P<0.001), but nearly 2 of 3 study participants did not achieve optimal control during the study. Site‐based risk‐factor control improved significantly in the first 6 months and over the long term in CREST but was often suboptimal. Intensive medical management should be considered for future trials of carotid revascularization. URL: ClinicalTrials.gov. Unique identifier: NCT00004732.