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Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial.
Journal article

Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial.

  • Bangalore S Division of Cardiology, New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com.
  • Fayyad R Pfizer, New York, New York.
  • Messerli FH Division of Cardiology, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai, Icahn School of Medicine, New York, New York.
  • Laskey R Pfizer, New York, New York.
  • DeMicco DA Pfizer, New York, New York.
  • Kastelein JJ Academic Medical Center/University of Amsterdam, The Netherlands.
  • Waters DD Division of Cardiology, San Francisco General Hospital, San Francisco, California.
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  • 2016-12-13
Published in:
  • The American journal of cardiology. - 2017
Aged
Anticholesteremic Agents
Antihypertensive Agents
Atorvastatin
Blood Pressure
Cardiovascular Diseases
Cause of Death
Cholesterol, LDL
Dyslipidemias
Female
Humans
Hypertension
Male
Middle Aged
Mortality
Myocardial Infarction
Proportional Hazards Models
Randomized Controlled Trials as Topic
Secondary Prevention
Simvastatin
Stroke
English In patients with previous myocardial infarction (MI), aggressive hypertension control and low-density lipoprotein cholesterol (LDL-C) reduction are important secondary prevention measures. However, residual risk remains despite aggressive treatment. Whether variability in blood pressure (BP) and LDL-C can explain this residual risk is not known. Patients enrolled in the Incremental Decrease in End Points Through Aggressive Lipid-Lowering trial with at least 1 post-baseline measurement of LDL-C and blood pressure (BP) were included. Visit-to-visit LDL-C and BP variabilities were evaluated using various measures of variability. Primary outcome was any coronary event with the secondary outcomes of any cardiovascular event (CV), MI, stroke, death, and CV death. Among the 8,658 patients included, each 1-SD (10.8 mg/dl) increase in LDL-C variability increased the risk of any coronary event (adjusted HR [HRadj] 1.07; 95% CI 1.04 to 1.11; p <0.0001), any CV event, MI, and death (HRadj 1.19; 95% CI 1.14 to 1.25; p <0.0001). Similarly, each 1-SD (7.2 mm Hg) increase in systolic BP variability increased the risk of any coronary event (HRadj 1.15; 95% CI 1.10 to 1.20; p <0.0001), any CV event, MI, stroke, death (HRadj 1.28; 95% CI 1.18 to 1.38; p <0.0001), and CV death. Compared with the group with low variability for both LDL-C and systolic BP, the group with high variability for both had a significant increase in any coronary event (HRadj 1.48; 95% CI 1.30 to 1.70), any CV event (HRadj 1.43; 95% CI 1.27 to 1.61), and MI (HRadj 1.87; 95% CI 1.46 to 2.41). In conclusions, in patients with a history of MI, variabilities in LDL-C and BP are powerful and independent predictors of CV events including death.
Language
  • English
Open access status
closed
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Persistent URL
https://sonar.ch/global/documents/177832
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