title: Management of vascular risk factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST).
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.
  
  
  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.
  
  
  BACKGROUND
  ClinicalTrials.gov. Unique identifier: NCT00004732.
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., M.L., T.G.B.).
authors.forename: James F
authors.initials: JF
authors.lastname: Meschia
authors.affiliation: Department of Neurosciences, Medical University of South Carolina, Charleston, SC (J.H.V.).
authors.forename: Jenifer H
authors.initials: JH
authors.lastname: Voeks
authors.affiliation: Cardiovascular Diseases and Interventional Cardiology, Providence Spokane Heart Institute, Spokane, WA (P.P.L.).
authors.forename: Pierre P
authors.initials: PP
authors.lastname: Leimgruber
authors.affiliation: Vascular Surgery, Mercy Clinic, St. Louis, MO (V.A.M.).
authors.forename: Vito A
authors.initials: VA
authors.lastname: Mantese
authors.affiliation: Vascular Surgery, University of Texas Southwestern Medical Center/VA North Texas Care System, Dallas, TX (C.H.T.).
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Timaran
authors.affiliation: Department of Neurology, The Methodist Hospital, Houston, TX (D.C.).
authors.forename: David
authors.initials: D
authors.lastname: Chiu
authors.affiliation: Department of Neurology, Mayo Clinic, Scottsdale, AZ (B.M.D.).
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, AL (V.J.H.).
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ (S.E.H.).
authors.forename: Susan E
authors.initials: SE
authors.lastname: Hughes
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., M.L., T.G.B.).
authors.forename: Mary
authors.initials: M
authors.lastname: Longbottom
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, NC (A.G.H.).
authors.forename: Annie Green
authors.initials: AG
authors.lastname: Howard
authors.affiliation: Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., M.L., T.G.B.).
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Brott
mesh_terms: D017130:Angioplasty / Q000295:instrumentation*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D008078:Cholesterol, LDL / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D016894:Endarterectomy, Carotid; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D015607:Stents; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D008078:Cholesterol, LDL; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents
keywords: carotid stenosis; clinical trials; revascularization; risk factors; stroke