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Baseline characteristics of HPS participants by prior cerebrovascular disease.

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Presentation on theme: "Baseline characteristics of HPS participants by prior cerebrovascular disease."— Presentation transcript:

1

2 Baseline characteristics of HPS participants by prior cerebrovascular disease

3 Baseline lipids (mmol/L) and apolipoproteins (g/L) by prior cerebrovascular disease

4 Baseline lipids (mg/dL) and apolipoproteins (g/L) by prior cerebrovascular disease

5 FACTORIAL TREATMENT COMPARISONS

6 (10269)(10267) SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Type 290409 Ischaemic 5153 Haemorrhagic 103134 Unknown Severity 96119 Fatal 4251 Severe 107155 Moderate 138189 Mild 6171 Unknown (4.3%)(5.7%) 25% SE 5 reduction 444585 (2P<0.00001) ALL STROKES 0.40.60.81.01.21.4 HPS: Stroke Incidence

7 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Age (years) < 65164195(3.3%)(4.0%) ≥ 65 < 70110154(4.5%)(6.3%) ≥ 70170236(5.8%)(8.2%) Sex Male331453(4.3%)(5.9%) Female113132(4.4%)(5.2%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: STROKE incidence by AGE & SEX

8 (10269)(10267) SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature Age 8311091(16.9%)(22.1%)< 65 512665(20.9%)(27.2%)65 - 69 548620(23.8%)(27.7%)70 - 74 142209(23.1%)(32.3%)  75 Sex 16662135(21.6%)(27.6%)Male 367450(14.4%)(17.7%)Female 24% SE 3 reduction (2P<0.00001) 20332585(19.8%)(25.2%)ALL PATIENTS 0.40.60.81.01.21.4 HPS: MAJOR VASCULAR EVENT by AGE & SEX

9 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Prior coronary disease Yes265347(4.0%)(5.2%) No179238(5.0%)(6.7%) Prior cerebrovascular disease Yes169170(10.3%)(10.4%) No275415(3.2%)(4.8%) Prior diabetes Yes149193(5.0%)(6.5%) No295392(4.0%)(5.4%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: STROKE by PRIOR DISEASE

10 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Prior coronary disease Yes175237(2.6%)(3.5%) No115172(3.2%)(4.8%) Prior cerebrovascular disease Yes100122(6.1%)(7.5%) No190287(2.2%)(3.3%) Prior diabetes Yes102140(3.4%)(4.7%) No188269(2.6%)(3.7%) ALL PATIENTS290409(2.8%)(4.0%) 30% SE 6 reduction (2P<0.00001wœ4õ) 0.40.60.81.01.21.4 HPS: ISCHAEMIC STROKE by PRIOR DISEASE

11 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Prior coronary disease Yes14591841(21.8%)(27.5%) No574744(16.1%)(20.8%) Prior cerebrovascular disease Yes406488(24.7%)(29.8%) No16272097(18.9%)(24.3%) Prior diabetes Yes601748(20.2%)(25.1%) No14321837(19.6%)(25.2%) ALL PATIENTS20332585(19.8%)(25.2%) 24% SE 3 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: MAJOR VASCULAR EVENTS by PRIOR DISEASE

12 Absolute effects on major vascular events and strokes subdivided by prior cerebrovascular disease S S P P Yes No Prior cerebrovascular disease Major vascular event (%) Risk reductions (SE): Proportional Absolute/1000 P-value 20% (6) 58 (18) p=0.001 25% (3) 60 (7) p<0.0001 Other event Stroke

13 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) LDL cholesterol (mmol/L) < 3.0137194(4.0%)(5.7%) ≥ 3.0 < 3.5108155(4.2%)(6.2%) > 3.5199236(4.6%)(5.4%) HDL cholesterol (mmol/L) < 0.9170199(4.7%)(5.6%) ≥ 0.9 < 1.1115166(4.1%)(5.8%) > 1.1159220(4.1%)(5.7%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: STROKE incidence by BASELINE LIPIDS

14 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) LDL cholesterol (mmol/L) < 3.0598756(17.6%)(22.2%) ≥ 3.0 < 3.5484646(19.0%)(25.7%) > 3.59511183(22.0%)(27.2%) HDL cholesterol (mmol/L) < 0.98181064(22.6%)(29.9%) ≥ 0.9 < 1.1560720(20.0%)(25.1%) > 1.1655801(17.0%)(20.9%) ALL PATIENTS20332585(19.8%)(25.2%) 24% SE 3 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: MAJOR VASCULAR EVENTS by BASELINE LIPIDS

15 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Diastolic blood pressure (mmHg) < 80176239(3.9%)(5.2%) ≥ 80 < 90131185(4.0%)(5.8%) ≥ 90137160(5.6%)(6.5%) Systolic blood pressure (mmHg) < 140162189(3.6%)(4.2%) ≥ 140 < 160121169(3.9%)(5.3%) ≥ 160161226(6.1%)(8.8%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: STROKE incidence by baseline BLOOD PRESSURE

16 (10269)(10267) SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature DBP (mmHg) 9171210(20.4%)(26.4%)< 80 644753(19.5%)(23.5%)  80 < 90 472621(19.2%)(25.1%)  90 SBP (mmHg) 8801064(19.4%)(23.5%)< 140 553772(17.9%)(24.4%)  140 < 160 600748(22.7%)(29.2%)  160 24% SE 3 reduction (2P<0.00001) 20332585(19.8%)(25.2%)ALL PATIENTS 0.40.60.81.01.21.4 HPS: MAJOR VASCULAR EVENTS by baseline BLOOD PRESSURE

17 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Treated hypertension Yes223274(5.3%)(6.5%) No221311(3.6%)(5.2%) Aspirin Yes286378(4.4%)(5.8%) No158207(4.2%)(5.5%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: STROKE incidence by TREATED HYPERTENSION and ASPIRIN USE

18 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Baseline feature (10269)(10267) Treated hypertension Yes9421195(22.4%)(28.1%) No10911390(18.0%)(23.1%) Aspirin Yes13701784(21.1%)(27.4%) No663801(17.5%)(21.3%) ALL PATIENTS20332585(19.8%)(25.2%) 24% SE 3 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS: MAJOR VASCULAR EVENTS by TREATED HYPERTENSION & ASPIRIN USE

19 SIMVASTATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Year of follow-up (10269)(10267) 187106(0.8%)(1.0%) 281132(0.8%)(1.3%) 382111(0.8%)(1.2%) 481111(0.9%)(1.2%) 5+113125(1.2%)(1.4%) ALL PATIENTS444585(4.3%)(5.7%) 25% SE 5 reduction (2P<0.00001) 0.40.60.81.01.21.4 HPS : STROKE incidence by YEAR

20 Years of follow-up PLACEBO SIMVASTATIN Benefit/1000(SE)2(1)7(2)10(2)13(3)14(4)15(10) Logrank p<0.0001 0123456 0 1 2 3 4 5 6 7 Proportion with stroke HPS: STROKE by YEAR

21 STATINPLACEBORate ratio & 95% CI STATIN betterPLACEBO better Study GREACE917(1.1%)(2.1%) AFCAPS/TexcAPS1417(0.4%)(0.5%) Post-CABG1816(2.7%)(2.4%) GISSI2019(0.9%) WOSCOPS4651(1.4%)(1.5%) CARE5276(2.5%)(3.7%) SSSS5676(2.5%)(3.4%) ASCOT89121(1.7%)(2.4%) PROSPER135131(4.7%)(4.5%) LIPID169204(3.7%)(4.5%) ALLHAT209231(4.0%)(4.5%) HPS444585(4.3%)(5.7%) ALL PATIENTS12611544(3.0%)(3.6%) 21% SE 4 reduction (2P<0.00001) 0.40.60.81.01.21.4 Effects on STROKE in major STATIN trials

22 HPS: Conclusions for people with cerebrovascular disease Lowering LDL cholesterol by 1 mmol/L (40 mg/dL) reduces the 5-year risk of ischaemic stroke by about one-quarter, with no apparent adverse effect on cerebral haemorrhage Similar proportional reductions in stroke risk are seen with statin therapy irrespective of age, sex, lipid levels, blood pressure, or use of other medications (including aspirin) Statin therapy clearly reduces the risk of major vascular events among people with pre-existing cerebrovascular disease, irrespective of the presence of coronary disease

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