title: Relationship between risk factor control and vascular events in the SAMMPRIS trial.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  NCT00576693.
authors.affiliation: 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.
authors.forename: Tanya N
authors.initials: TN
authors.lastname: Turan
authors.affiliation: 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.
authors.forename: Azhar
authors.initials: A
authors.lastname: Nizam
authors.affiliation: 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.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lynn
authors.affiliation: 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.
authors.forename: Brent M
authors.initials: BM
authors.lastname: Egan
authors.affiliation: 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.
authors.forename: Ngoc-Anh
authors.initials: NA
authors.lastname: Le
authors.affiliation: 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.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Lopes-Virella
authors.affiliation: 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.
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Hermayer
authors.affiliation: 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.
authors.forename: Jamie
authors.initials: J
authors.lastname: Harrell
authors.affiliation: 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.
authors.forename: Colin P
authors.initials: CP
authors.lastname: Derdeyn
authors.affiliation: 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.
authors.forename: David
authors.initials: D
authors.lastname: Fiorella
authors.affiliation: 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.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Janis
authors.affiliation: 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.
authors.forename: Bethany
authors.initials: B
authors.lastname: Lane
authors.affiliation: 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.
authors.forename: Jean
authors.initials: J
authors.lastname: Montgomery
authors.affiliation: 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.
authors.forename: Marc I
authors.initials: MI
authors.lastname: Chimowitz
mesh_terms: D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D055502:Secondary Prevention; D012907:Smoking / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D015607:Stents; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002784:Cholesterol