Management of vascular risk factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

J Am Heart Assoc. 2014 Nov 26;3(6):e001180. doi: 10.1161/JAHA.114.001180.

Abstract

Background: 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.

Methods and results: 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.

Conclusions: 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.

Clinical trial registration url: ClinicalTrials.gov. Unique identifier: NCT00004732.

Keywords: carotid stenosis; clinical trials; revascularization; risk factors; stroke.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angioplasty / instrumentation*
  • Antihypertensive Agents / therapeutic use*
  • Biomarkers / blood
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • Blood Pressure / drug effects
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / epidemiology
  • Carotid Stenosis / surgery
  • Carotid Stenosis / therapy*
  • Cholesterol, LDL / blood
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / epidemiology
  • Dyslipidemias / blood
  • Dyslipidemias / diagnosis
  • Dyslipidemias / drug therapy*
  • Dyslipidemias / epidemiology
  • Endarterectomy, Carotid*
  • Humans
  • Hypertension / diagnosis
  • Hypertension / drug therapy*
  • Hypertension / epidemiology
  • Hypertension / physiopathology
  • Hypoglycemic Agents / therapeutic use*
  • Hypolipidemic Agents / therapeutic use*
  • Risk Assessment
  • Risk Factors
  • Secondary Prevention
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Smoking Cessation*
  • Smoking Prevention*
  • Stents*
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Antihypertensive Agents
  • Biomarkers
  • Blood Glucose
  • Cholesterol, LDL
  • Hypoglycemic Agents
  • Hypolipidemic Agents

Associated data

  • ClinicalTrials.gov/NCT00004732