title: Differing predictive relationships between baseline LDL-C, systolic blood pressure, and cardiovascular outcomes.
abstract: BACKGROUND
  Traditional cardiovascular risk factors, such as hypertension and dyslipidemia, predispose individuals to cardiovascular disease, particularly patients with diabetes. We investigated the predictive value of baseline systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) on the risk of vascular outcomes in a large population of patients at high risk of future cardiovascular events.
  
  
  METHODS
  Data were pooled from the TNT (Treating to New Targets), CARDS (Collaborative Atorvastatin Diabetes Study), and IDEAL (Incremental Decrease in End-Points Through Aggressive Lipid Lowering) trials and included a total of 21,727 patients (TNT: 10,001; CARDS: 2838; IDEAL: 8888). The effect of baseline SBP and LDL-C on cardiovascular events, coronary events, and stroke was evaluated using a multivariate Cox proportional-hazards model.
  
  
  RESULTS
  Overall, risk of cardiovascular events was significantly higher for patients with higher baseline SBP or LDL-C. Higher baseline SBP was significantly predictive of stroke but not coronary events. Conversely, higher baseline LDL-C was significantly predictive of coronary events but not stroke. Results from the subgroup with diabetes (5408 patients; TNT: 1501; CARDS: 2838; IDEAL: 1069) were broadly consistent with those of the total cohort: baseline SBP and LDL-C were significantly predictive of cardiovascular events overall, with the association to LDL-C predominantly related to an effect on coronary events. However, baseline SBP was not predictive of either coronary or stroke events in the pooled diabetic population.
  
  
  CONCLUSIONS
  In this cohort of high-risk patients, baseline SBP and LDL-C were significantly predictive of cardiovascular outcomes, but this effect may differ between the cerebrovascular and coronary systems.
  
  
  BACKGROUND
  NCT00327691 (TNT); NCT00327418 (CARDS); NCT00159835 (IDEAL).
authors: UCSF School of Medicine, Cardiology Division, Fresno, CA, USA. Electronic address: pdeedwania@fresno.ucsf.edu.
authors: Prakash C
authors: PC
authors: Deedwania
authors: Oslo University Hospital, Oslo, Norway. Electronic address: t.r.pedersen@medisin.uio.no.
authors: Terje R
authors: TR
authors: Pedersen
authors: Pfizer, New York, NY, USA. Electronic address: david.demicco@pfizer.com.
authors: David A
authors: DA
authors: DeMicco
authors: Pfizer, New York, NY, USA. Electronic address: andrei.breazna@pfizer.com.
authors: Andrei
authors: A
authors: Breazna
authors: University College London Hospitals, London, UK. Electronic address: j.betteridge@ucl.ac.uk.
authors: D John
authors: DJ
authors: Betteridge
authors: Queen Mary University of London, London, UK. Electronic address: g.a.hitman@qmul.ac.uk.
authors: Graham A
authors: GA
authors: Hitman
authors: Cardiovascular Research Group, University of Manchester, Manchester, UK. Electronic address: pdurrington@manchester.ac.uk.
authors: Paul
authors: P
authors: Durrington
authors: University of Oxford, Oxford, UK. Electronic address: andrew.neil@wolfson.ox.ac.uk.
authors: Andrew
authors: A
authors: Neil
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000175:diagnosis* / Q000503:physiopathology; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL
keywords: Cardiovascular disease; Cardiovascular risk prediction; Diabetes; Low-density lipoprotein cholesterol; Stroke; Systolic blood pressure