Management of vascular risk factors in the carotid revascularization endarterectomy versus stenting trial (CREST)

Background-the carotid revascularization endarterectomy versus stenting trial (crest) is a multicenter randomized trial of stenting versus endarterectomy in patients with symptomatic and asymptomatic carotid disease. this study assesses management of vascular risk factors. methods and results-management was provided by the patient's physician,with biannual monitoring results collected by the local site. therapeutic targets were low-density lipoprotein,cholesterol <100 mg/dl,systolic blood pressure <140 mm hg,fasting blood glucose <126 mg/dl,and nonsmoking status. optimal control was defined as achieving all 4 goals concurrently. generalized estimating equations were used to compare risk factors at baseline with those observed in scheduled follow-up visits for up to 48 months. in the analysis cohort of 2210,significant improvements in risk-factor control were observed across risk factors for all follow-up visits compared with baseline. at 48 months,achievement of the low-density lipoprotein cholesterol goal improved from 59.1% to 73.6% (p<0.001),achievement of the systolic blood pressure goal improved from 51.6% to 65.1% (p<0.001),achievement of the glucose goal improved from 74.9% to 80.7% (p=0.0101),and nonsmoking improved from 74.4% to 80.9% (p<0.0001). the percentage with optimal risk-factor control also improved significantly,from 16.7% to 36.2% (p<0.001),but nearly 2 of 3 study participants did not achieve optimal control during the study. conclusions-site-based risk-factor control improved significantly in the first 6 months and over the long term in crest but was often suboptimal. intensive medical management should be considered for future trials of carotid revascularization. © 2014 the authors.