baseline characteristics of hps participants by prior cerebrovascular disease

Baseline characteristics of HPS participantsby prior cerebrovascular disease

Cerebrovascular disease (3280)

No cerebrovascular disease (17 256)

Age (years) 65.5 63.7

Men 2445 (75%) 13 009 (75%)

Current smoker 534 (16%) 2379 (14%)

Coronary disease Prior MI 896 (27%) 7614 (44%)

Other CHD 564 (17%) 4312 (25%)

None 1820 (55%) 5330 (31%)

Hypertension 1655 (50%) 6802 (39%)

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



Total cholesterol 5.9 5.8

LDL 3.4 3.4

HDL 1.08 1.05

Triglycerides 2.1 2.1

Apo A1 1.21 1.20

Apo B 1.16 1.14

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



Total cholesterol 228 225

LDL 132 132

HDL 42 41

Triglycerides 189 189

Apo A1 1.21 1.20

Apo B 1.16 1.14

Simvastatin(40 mg daily)

vs Placebotablets

Vitamins(600 mg E, 250 mg C& 20 mg beta-carotene)

vs Placebocapsules

5 years average duration of follow-up

FACTORIAL TREATMENT COMPARISONS

(10269) (10267)

SIMVASTATIN PLACEBO Rate ratio & 95% CI

STATIN better PLACEBO better

Type

290 409Ischaemic51 53Haemorrhagic

103 134Unknown

Severity

96 119Fatal42 51Severe

107 155Moderate138 189Mild

61 71Unknown

(4.3%) (5.7%)25% SE 5reduction

444 585

(2P<0.00001)

ALL STROKES

0.4 0.6 0.8 1.0 1.2 1.4

HPS: Stroke Incidence



Baselinefeature (10269) (10267)

Age (years)

< 65 164 195(3.3%) (4.0%)

≥ 65 < 70 110 154(4.5%) (6.3%)

≥ 70 170 236(5.8%) (8.2%)

Sex

Male 331 453(4.3%) (5.9%)

Female 113 132(4.4%) (5.2%)

ALL PATIENTS 444 585(4.3%) (5.7%)25% SE 5reduction(2P<0.00001)

0.4 0.6 0.8 1.0 1.2 1.4

HPS: STROKE incidence by AGE & SEX

(10269) (10267)



Baselinefeature

Age

831 1091(16.9%) (22.1%)< 65

512 665(20.9%) (27.2%)65 - 69

548 620(23.8%) (27.7%)70 - 74

142 209(23.1%) (32.3%) 75

Sex

1666 2135(21.6%) (27.6%)Male

367 450(14.4%) (17.7%)Female

24% SE 3reduction(2P<0.00001)

2033 2585(19.8%) (25.2%)ALL PATIENTS

0.4 0.6 0.8 1.0 1.2 1.4

HPS: MAJOR VASCULAR EVENT by AGE & SEX




Prior coronary disease

Yes 265 347(4.0%) (5.2%)

No 179 238(5.0%) (6.7%)

Prior cerebrovascular disease

Yes 169 170(10.3%) (10.4%)

No 275 415(3.2%) (4.8%)

Prior diabetes

Yes 149 193(5.0%) (6.5%)

No 295 392(4.0%) (5.4%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: STROKE by PRIOR DISEASE





Yes 175 237(2.6%) (3.5%)

No 115 172(3.2%) (4.8%)


Yes 100 122(6.1%) (7.5%)

No 190 287(2.2%) (3.3%)

Prior diabetes

Yes 102 140(3.4%) (4.7%)

No 188 269(2.6%) (3.7%)

ALL PATIENTS 290 409(2.8%) (4.0%)30% SE 6reduction(2P<0.00001wœ4õ)

0.4 0.6 0.8 1.0 1.2 1.4

HPS: ISCHAEMIC STROKE by PRIOR DISEASE

SIMVASTATIN PLACEBO Rate ratio & 95% CISTATIN better PLACEBO better



Yes 1459 1841(21.8%) (27.5%)

No 574 744(16.1%) (20.8%)


Yes 406 488(24.7%) (29.8%)

No 1627 2097(18.9%) (24.3%)

Prior diabetes

Yes 601 748(20.2%) (25.1%)

No 1432 1837(19.6%) (25.2%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: MAJOR VASCULAR EVENTS by PRIOR DISEASE

0

10

20

30

0

10

20

30

Absolute effects on major vascular events and strokes subdivided by prior cerebrovascular disease

S

S

P

P

Yes No


Maj

or

vas

cula

r ev

ent

(%)

Risk reductions (SE):

ProportionalAbsolute/1000P-value

20% (6)58 (18)p=0.001

25% (3) 60 (7)

p<0.0001Other event

Stroke




LDL cholesterol (mmol/L)

< 3.0 137 194(4.0%) (5.7%)

≥ 3.0 < 3.5 108 155(4.2%) (6.2%)

> 3.5 199 236(4.6%) (5.4%)

HDL cholesterol (mmol/L)

< 0.9 170 199(4.7%) (5.6%)

≥ 0.9 < 1.1 115 166(4.1%) (5.8%)

> 1.1 159 220(4.1%) (5.7%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: STROKE incidence by BASELINE LIPIDS



LDL cholesterol (mmol/L)

< 3.0 598 756(17.6%) (22.2%)

≥ 3.0 < 3.5 484 646(19.0%) (25.7%)

> 3.5 951 1183(22.0%) (27.2%)

HDL cholesterol (mmol/L)

< 0.9 818 1064(22.6%) (29.9%)

≥ 0.9 < 1.1 560 720(20.0%) (25.1%)

> 1.1 655 801(17.0%) (20.9%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: MAJOR VASCULAR EVENTS by BASELINE LIPIDS




Diastolic blood pressure (mmHg)

< 80 176 239(3.9%) (5.2%)

≥ 80 < 90 131 185(4.0%) (5.8%)

≥ 90 137 160(5.6%) (6.5%)

Systolic blood pressure (mmHg)

< 140 162 189(3.6%) (4.2%)

≥ 140 < 160 121 169(3.9%) (5.3%)

≥ 160 161 226(6.1%) (8.8%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: STROKE incidence by baselineBLOOD PRESSURE

(10269) (10267)SIMVASTATIN PLACEBO Rate ratio & 95% CI

STATIN better PLACEBO betterBaselinefeature

DBP (mmHg)

917 1210(20.4%) (26.4%)< 80

644 753(19.5%) (23.5%) 80 < 90

472 621(19.2%) (25.1%) 90

SBP (mmHg)

880 1064(19.4%) (23.5%)< 140

553 772(17.9%) (24.4%) 140 < 160

600 748(22.7%) (29.2%) 160

24% SE 3reduction(2P<0.00001)

2033 2585(19.8%) (25.2%)ALL PATIENTS

0.4 0.6 0.8 1.0 1.2 1.4

HPS: MAJOR VASCULAR EVENTS by baselineBLOOD PRESSURE




Treated hypertension

Yes 223 274(5.3%) (6.5%)

No 221 311(3.6%) (5.2%)

Aspirin

Yes 286 378(4.4%) (5.8%)

No 158 207(4.2%) (5.5%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: STROKE incidence by TREATED HYPERTENSION and ASPIRIN USE



Treated hypertension

Yes 942 1195(22.4%) (28.1%)

No 1091 1390(18.0%) (23.1%)

Aspirin

Yes 1370 1784(21.1%) (27.4%)

No 663 801(17.5%) (21.3%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS: MAJOR VASCULAR EVENTS by TREATED HYPERTENSION & ASPIRIN USE



Year offollow-up (10269) (10267)

1 87 106(0.8%) (1.0%)

2 81 132(0.8%) (1.3%)

3 82 111(0.8%) (1.2%)

4 81 111(0.9%) (1.2%)

5+ 113 125(1.2%) (1.4%)


0.4 0.6 0.8 1.0 1.2 1.4

HPS : STROKE incidence by YEAR

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

0 1 2 3 4 5 60

1

2

3

4

5

6

7P

ropo

rtio

n w

ith s

trok

eHPS: STROKE by YEAR

STATIN PLACEBO Rate ratio & 95% CI


Study

GREACE 9 17(1.1%) (2.1%)

AFCAPS/TexcAPS 14 17(0.4%) (0.5%)

Post-CABG 18 16(2.7%) (2.4%)

GISSI 20 19(0.9%) (0.9%)

WOSCOPS 46 51(1.4%) (1.5%)

CARE 52 76(2.5%) (3.7%)

SSSS 56 76(2.5%) (3.4%)

ASCOT 89 121(1.7%) (2.4%)

PROSPER 135 131(4.7%) (4.5%)

LIPID 169 204(3.7%) (4.5%)

ALLHAT 209 231(4.0%) (4.5%)

HPS 444 585(4.3%) (5.7%)


0.4 0.6 0.8 1.0 1.2 1.4

Effects on STROKE in major STATIN trials

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

baseline characteristics of hps participants by prior cerebrovascular disease

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