Prior events predict cerebrovascular and coronary outcomes in the PROGRESS trial
Identifieur interne : 009C83 ( Main/Exploration ); précédent : 009C82; suivant : 009C84Prior events predict cerebrovascular and coronary outcomes in the PROGRESS trial
Auteurs : Hisatomi Arima [Australie] ; Christophe Tzourio [France] ; Ken Butcher [Australie] ; Craig Anderson [Australie] ; Marie-Germaine Bousser [France] ; Kennedy R. Lees [Royaume-Uni] ; John L. Reid [Royaume-Uni] ; Teruo Omae [Japon] ; Mark Woodward [Australie] ; Stephen Macmahon [Australie] ; John Chalmers [Australie]Source :
- Stroke : (1970) [ 0039-2499 ] ; 2006.
Descripteurs français
- Pascal (Inist)
English descriptors
- KwdEn :
Abstract
Background and Purpose-The relationship between baseline and recurrent vascular events may be important in the targeting of secondary prevention strategies. We examined the relationship between initial event and various types of further vascular outcomes and associated effects of blood pressure (BP)-lowering. Methods-Subsidiary analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial that established the benefits of BP-lowering in 6105 patients (mean age 64 years, 30% female) with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, plus indapamide in those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s). Results-Stroke subtypes and coronary events were associated with 1.5- to 6.6-fold greater risk of recurrence of the same event (hazard ratios, 1.51 to 6.64; P=0.1 for large artery infarction, P<0.0001 for other events). However, 46% to 92% of further vascular outcomes were not of the same type. Active treatment produced comparable reductions in the risk of vascular outcomes among patients with a broad range of vascular events at entry (relative risk reduction, 25%; P<0.0001 for ischemic stroke; 42%, P=0.0006 for hemorrhagic stroke; 17%, P=0.3 for coronary events; P homogeneity=0.4). Conclusions-Patients with previous vascular events are at high risk of recurrences of the same event. However, because they are also at risk of other vascular outcomes, a broad range of secondary prevention strategies is necessary for their treatment. BP-lowering is likely to be one of the most effective and generalizable strategies across a variety of major vascular events including stroke and myocardial infarction.
Affiliations:
- Australie, France, Japon, Royaume-Uni
- Nouvelle-Galles du Sud, Écosse, Île-de-France
- Glasgow, Paris, Sydney
- Université de Glasgow, Université de Sydney
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Lees</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Division of Cardiovascular and Medical Sciences, University of Glasgow</s1><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Reid, John L" sort="Reid, John L" uniqKey="Reid J" first="John L." last="Reid">John L. Reid</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Division of Cardiovascular and Medical Sciences, University of Glasgow</s1><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Omae, Teruo" sort="Omae, Teruo" uniqKey="Omae T" first="Teruo" last="Omae">Teruo Omae</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>National Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>8 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>National Cardiovascular Center</wicri:noRegion></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name 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Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>INSERM U708</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Butcher, Ken" sort="Butcher, Ken" uniqKey="Butcher K" first="Ken" last="Butcher">Ken Butcher</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Bousser, Marie Germaine" sort="Bousser, Marie Germaine" uniqKey="Bousser M" first="Marie-Germaine" last="Bousser">Marie-Germaine Bousser</name><affiliation wicri:level="3"><inist:fA14 i1="03"><s1>Department of Neurology, Hospital Lariboisière</s1><s2>Paris</s2><s3>FRA</s3><sZ>5 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Lees, Kennedy R" sort="Lees, Kennedy R" uniqKey="Lees K" first="Kennedy R." last="Lees">Kennedy R. Lees</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Division of Cardiovascular and Medical Sciences, University of Glasgow</s1><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Reid, John L" sort="Reid, John L" uniqKey="Reid J" first="John L." last="Reid">John L. Reid</name><affiliation wicri:level="4"><inist:fA14 i1="04"><s1>Division of Cardiovascular and Medical Sciences, University of Glasgow</s1><s3>GBR</s3><sZ>6 aut.</sZ><sZ>7 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Glasgow</settlement><region type="country">Écosse</region></placeName><orgName type="university">Université de Glasgow</orgName></affiliation></author><author><name sortKey="Omae, Teruo" sort="Omae, Teruo" uniqKey="Omae T" first="Teruo" last="Omae">Teruo Omae</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>National Cardiovascular Center</s1><s2>Suita</s2><s3>JPN</s3><sZ>8 aut.</sZ></inist:fA14><country>Japon</country><wicri:noRegion>National Cardiovascular Center</wicri:noRegion></affiliation></author><author><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>The George Institute for International Health, University of Sydney</s1><s3>AUS</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>9 aut.</sZ><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author></analytic><series><title level="j" type="main">Stroke : (1970)</title><title level="j" type="abbreviated">Stroke : (1970)</title><idno type="ISSN">0039-2499</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Stroke : (1970)</title><title level="j" type="abbreviated">Stroke : (1970)</title><idno type="ISSN">0039-2499</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Antihypertensive agent</term><term>Cerebrovascular disease</term><term>Coronary heart disease</term><term>Myocardial infarction</term><term>Nervous system diseases</term><term>Prognosis</term><term>Stroke</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Système nerveux pathologie</term><term>Cérébrovasculaire pathologie</term><term>Accident cérébrovasculaire</term><term>Cardiopathie coronaire</term><term>Infarctus myocarde</term><term>Pronostic</term><term>Antihypertenseur</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background and Purpose-The relationship between baseline and recurrent vascular events may be important in the targeting of secondary prevention strategies. We examined the relationship between initial event and various types of further vascular outcomes and associated effects of blood pressure (BP)-lowering. Methods-Subsidiary analyses of the Perindopril Protection Against Recurrent Stroke Study (PROGRESS) trial, a randomized, placebo-controlled trial that established the benefits of BP-lowering in 6105 patients (mean age 64 years, 30% female) with cerebrovascular disease, randomly assigned to either active treatment (perindopril for all, plus indapamide in those with neither an indication for, nor a contraindication to, a diuretic) or placebo(s). Results-Stroke subtypes and coronary events were associated with 1.5- to 6.6-fold greater risk of recurrence of the same event (hazard ratios, 1.51 to 6.64; P=0.1 for large artery infarction, P<0.0001 for other events). However, 46% to 92% of further vascular outcomes were not of the same type. Active treatment produced comparable reductions in the risk of vascular outcomes among patients with a broad range of vascular events at entry (relative risk reduction, 25%; P<0.0001 for ischemic stroke; 42%, P=0.0006 for hemorrhagic stroke; 17%, P=0.3 for coronary events; P homogeneity=0.4). Conclusions-Patients with previous vascular events are at high risk of recurrences of the same event. However, because they are also at risk of other vascular outcomes, a broad range of secondary prevention strategies is necessary for their treatment. BP-lowering is likely to be one of the most effective and generalizable strategies across a variety of major vascular events including stroke and myocardial infarction.</div></front></TEI><affiliations><list><country><li>Australie</li><li>France</li><li>Japon</li><li>Royaume-Uni</li></country><region><li>Nouvelle-Galles du Sud</li><li>Écosse</li><li>Île-de-France</li></region><settlement><li>Glasgow</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Glasgow</li><li>Université de Sydney</li></orgName></list><tree><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Arima, Hisatomi" sort="Arima, Hisatomi" uniqKey="Arima H" first="Hisatomi" last="Arima">Hisatomi Arima</name></region><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><name sortKey="Butcher, Ken" sort="Butcher, Ken" uniqKey="Butcher K" first="Ken" last="Butcher">Ken Butcher</name><name sortKey="Chalmers, John" sort="Chalmers, John" uniqKey="Chalmers J" first="John" last="Chalmers">John Chalmers</name><name sortKey="Macmahon, Stephen" sort="Macmahon, Stephen" uniqKey="Macmahon S" first="Stephen" last="Macmahon">Stephen Macmahon</name><name sortKey="Woodward, Mark" sort="Woodward, Mark" uniqKey="Woodward M" first="Mark" last="Woodward">Mark Woodward</name></country><country name="France"><region name="Île-de-France"><name sortKey="Tzourio, Christophe" sort="Tzourio, Christophe" uniqKey="Tzourio C" first="Christophe" last="Tzourio">Christophe Tzourio</name></region><name sortKey="Bousser, Marie Germaine" sort="Bousser, Marie Germaine" uniqKey="Bousser M" first="Marie-Germaine" last="Bousser">Marie-Germaine Bousser</name></country><country name="Royaume-Uni"><region name="Écosse"><name sortKey="Lees, Kennedy R" sort="Lees, Kennedy R" uniqKey="Lees K" first="Kennedy R." last="Lees">Kennedy R. Lees</name></region><name sortKey="Reid, John L" sort="Reid, John L" uniqKey="Reid J" first="John L." last="Reid">John L. Reid</name></country><country name="Japon"><noRegion><name sortKey="Omae, Teruo" sort="Omae, Teruo" uniqKey="Omae T" first="Teruo" last="Omae">Teruo Omae</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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