Controling Risk Factors Reduces Risk of Stroke by 42%

Results of a new analysis of the Treating to New Targets (TNT) study show that intensive low-density lipoprotein (LDL) cholesterol-lowering in patients with stable coronary heart disease (CHD) whose systolic blood pressure was less than 140 mmHg reduced the risk of major cardiovascular events, including heart attack, stroke and resuscitated cardiac arrest, by 42 percent compared with less intensive LDL lowering and uncontrolled blood pressure of 140 mmHg or higher.

Led by John B. Kostis, MD, the John G. Detwiler professor of cardiology, professor of medicine and chair, department of medicine, UMDNJ-Robert Wood Johnson Medical School, UMDNJ-Robert Wood Johnson Medical School, and chief of medical service at Robert Wood Johnson University Hospital, this post-hoc analysis of the five-year 10,001 patient TNT study that was funded by Pfizer, Inc., was published in the May 2008 issue of the Journal of Clinical Hypertension.

“People who have both high cholesterol and high blood pressure are at greater risk for cardiovascular disease than those with either condition alone.Yet, a minority of patients with both conditions is treated to currently recommended targets. In one study less than a third of such patients were treated and only one in ten were treated to target,” said Dr. Kostis. “The analysis reported today reminds us that intensive management of both cholesterol and blood pressure, can significantly reduce the risk of heart attacks and strokes.”

Among the 10,001 patients of TNT, 9,739 who had both LDL cholesterol and systolic blood pressure measured at three months after randomization, were included in this analysis. All patients received cholesterol-lowering therapy with atorvastatin calcium (Lipitor®) 80 mg or 10 mg. More than 95 percent of patients in this analysis also were receiving antihypertensive therapy.

As reported in the published analysis, patients were divided into groups based on LDL levels (73 mg/dL and lower; 74 to 94 mg/dL; or 95 mg/dL and higher) and systolic blood pressure (140 mmHg and higher, or lower than 140 mmHg) at three months. During a median follow-up of 4.9 years, patients with the lowest LDL and the lowest BP had the lowest risk of major cardiovascular events. For each of the three LDL groups, the rate of cardiovascular events was lower in patients whose systolic blood pressure (SBP) was below 140 mmHg. The benefit of SBP <140 mmHg with respect to stroke was most pronounced in the lowest LDL-C group. In this analysis Lipitor was well tolerated across all three LDL groups and both systolic BP categories.

“Overall, this study provides new evidence of the importance of controlling both dyslipidemia and hypertension” said Dr. Kostis. “However, controlling other risk factors, especially smoking, is still essential to reducing the risk of heart attack and stroke.”