Relationship between risk factor control and vascular events in the SAMMPRIS trial

Tanya N Turan; Azhar Nizam; Michael J Lynn; Brent M Egan; Ngoc-Anh Le; Maria F Lopes-Virella; Kathie L Hermayer; Jamie Harrell; Colin P Derdeyn; David Fiorella; L Scott Janis; Bethany Lane; Jean Montgomery; Marc I Chimowitz

doi:10.1212/WNL.0000000000003534

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Relationship between risk factor control and vascular events in the SAMMPRIS trial

Journal article

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Relationship between risk factor control and vascular events in the SAMMPRIS trial

Tanya N Turan, Azhar Nizam, Michael J Lynn, Brent M Egan, Ngoc-Anh Le, Maria F Lopes-Virella, Kathie L Hermayer, Jamie Harrell, Colin P Derdeyn, David Fiorella, …

Neurology, Vol.88(4), pp.379-385

01/24/2017

DOI: 10.1212/WNL.0000000000003534

PMCID: PMC5272964

PMID: 28003500

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Abstract

The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) study is the first stroke prevention trial to include protocol-driven 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. 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 follow-up of 32 months. For each patient, values for all risk factor measures were averaged and dichotomized as in or out of target. 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). 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. NCT00576693.

Blood Pressure

Body Mass Index

Multivariate Analysis

Myocardial Infarction - epidemiology

Follow-Up Studies

Smoking - therapy

Cholesterol - blood

Humans

Risk Factors

Logistic Models

Treatment Outcome

Secondary Prevention

Biomarkers - blood

Stroke - physiopathology

Myocardial Infarction - therapy

Exercise

Time Factors

Smoking - epidemiology

Smoking - physiopathology

Myocardial Infarction - physiopathology

Stroke - epidemiology

Stents

Stroke - therapy

Details

Title: Subtitle: Relationship between risk factor control and vascular events in the SAMMPRIS trial
Creators: Tanya N Turan - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD. turan@musc.edu
Azhar Nizam - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Michael J Lynn - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Brent M Egan - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Ngoc-Anh Le - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Maria F Lopes-Virella - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Kathie L Hermayer - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Jamie Harrell - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Colin P Derdeyn - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
David Fiorella - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
L Scott Janis - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Bethany Lane - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Jean Montgomery - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Marc I Chimowitz - From Medical University of South Carolina (T.N.T., M.F.L.-V., K.L.H., J.H., M.I.C.), Charleston; Emory University (A.N., M.J.L., B.L., J.M.), Atlanta, GA; University of South Carolina School of Medicine (B.M.E.), Greenville; Atlanta VAMC (N.-A.L.), Decatur, GA; Washington University (C.P.D.), St. Louis, MI; State University of New York at Stony Brook (D.F.); and National Institute of Neurological Disorders and Stroke (L.S.J.), Bethesda, MD
Resource Type: Journal article
Publication Details: Neurology, Vol.88(4), pp.379-385
Publisher: United States
DOI: 10.1212/WNL.0000000000003534
PMID: 28003500
PMCID: PMC5272964
ISSN: 0028-3878
eISSN: 1526-632X
Language: English
Date published: 01/24/2017
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984020602502771

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