title: Relation of Variability of Low-Density Lipoprotein Cholesterol and Blood Pressure to Events in Patients With Previous Myocardial Infarction from the IDEAL Trial.
abstract: 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 (HRadj1.19; 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 (HRadj1.15; 95% CI 1.10 to 1.20; p <0.0001), any CV event, MI, stroke, death (HRadj1.28; 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 (HRadj1.48; 95% CI 1.30 to 1.70), any CV event (HRadj1.43; 95% CI 1.27 to 1.61), and MI (HRadj1.87; 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.
authors.affiliation: Division of Cardiology, New York University School of Medicine, New York, New York. Electronic address: sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.affiliation: Pfizer, New York, New York.
authors.forename: Rana
authors.initials: R
authors.lastname: Fayyad
authors.affiliation: Division of Cardiology, University Hospital, Bern, Switzerland; Division of Cardiology, Mount Sinai, Icahn School of Medicine, New York, New York.
authors.forename: Franz H
authors.initials: FH
authors.lastname: Messerli
authors.affiliation: Pfizer, New York, New York.
authors.forename: Rachel
authors.initials: R
authors.lastname: Laskey
authors.affiliation: Pfizer, New York, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: DeMicco
authors.affiliation: Academic Medical Center/University of Amsterdam, The Netherlands.
authors.forename: John J P
authors.initials: JJ
authors.lastname: Kastelein
authors.affiliation: Division of Cardiology, San Francisco General Hospital, San Francisco, California.
authors.forename: David D
authors.initials: DD
authors.lastname: Waters
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D000069059:Atorvastatin / Q000627:therapeutic use; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000401:mortality; D002423:Cause of Death; D008078:Cholesterol, LDL / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D019821:Simvastatin / Q000627:therapeutic use; D020521:Stroke / Q000453:epidemiology
chemical_list: D000924:Anticholesteremic Agents; D000959:Antihypertensive Agents; D008078:Cholesterol, LDL; D000069059:Atorvastatin; D019821:Simvastatin