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Tii a model designed to predict whether the risk of events was higher in those with low systolic pressure or diastolic pressure or in those with both low systolic and diastolic pressures, the test for interaction was not significant, and the risk of events was comparable doqnload all 3 categories.

Overall BP effects donload examined on the basis of a likelihood ratio test that compared a full model that included both linear and quadratic mean BP terms plus other covariates in adjusted analysis only and a reduced model without the linear and quadratic mean BP terms.

The incidence ratio of nonfatal MI to stroke remained constant for a wide range of BPs; however, at lower diastolic pressures, the incidence of nonfatal MI was much higher than the incidence of stroke, which implies that a compromised coronary circulation resulting from low diastolic pressures could be a more important factor for MI than for stroke.

C, Incidence and adjusted risk of secondary outcome as a function of average follow-up diastolic BP categories. Kaplan—Meier rate of the triple endpoint by 2 years in diabetic vs.

Clinical Perspective

Diabetic patients with MI or angina treated with standard-statin therapy vs. If, however, a J- or U-shaped relationship was found with average follow-up BP but not at baseline, the BP itself was more likely to contribute to increased events at follow-up.

The lack of a significant interaction between DM and statin therapy on outcomes underlines that the response to the intensive regimen is not significantly different between diabetic and non-diabetic patients. It has been hypothesized that the J- or U-shaped curve may be an epiphenomenon of more severe underlying chronic illness including cancer or underlying severe cardiac illness like heart failurethereby increasing mortality. Primary endpoint was a composite of death, MI, unstable angina, revascularization at least 30 days post randomizationor stroke.

Share on Social Media. All analyses were performed according to the intent-to-treat principle.

Unadjusted hazard ratios were calculated on the basis of univariate Cox proportional hazards analysis that included BP and BP squared only.

J Biol Chem The prevalence of DM in our analysis was higher than in earlier secondary prevention statin trials which ranged from 4.

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Randomised trial of cholesterol lowering in patients with coronary heart disease: The end of follow-up adjusted C statistic of 0. Cookies We use cookies to improve your experience with our site. Classification of Diabetes Mellitus. To evaluate the effect of pulse pressure, we performed a sensitivity analysis that controlled for it. We assessed the association between baseline and achieved LDL-C and high-sensitivity C-reactive protein with the triple endpoint at 2 years.

This can be explained by impaired coronary perfusion and is a more likely explanation given that we observed a more pronounced J- or U-shaped curve effect with follow-up BP variables than with baseline BP variables. In addition, if the J- or U-shaped curve were due to reverse causality low BP variables being a mere dlwnload of ill healthtiimi relationship should have been seen with both baseline and average follow-up BP variables. tumi

TIMI Study Group – PROVE IT-TIMI 22

Cochrane Database Syst Rev. Share this Article Email. Benefits and potential harm of lowering high blood pressure. The linear relationship might hold true for the general population, but in patients with stable coronary artery disease, the relationship between BP and cardiovascular outcomes has been shown dosnload some studies to follow a J- or a U-shaped curve, with higher event rates at very low and very high BP.

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Published by Elsevier Inc. The Kaplan—Meier event rate for the triple endpoint on intensive vs. Murphy, Eugene Braunwald; Acute coronary syndromes and diabetes: A, Incidence and adjusted risk of primary outcome as a function of average follow-up systolic BP categories. Recommended articles Citing articles 0. Effects of atorvastatin on early recurrent ischaemic events in acute coronary syndromes: Progression of subclinical atherosclerosis in subjects with rheumatoid arthritis and the metabolic syndrome.

Usual versus tight control of systolic blood pressure in non-diabetic patients with hypertension Cardio-Sis: D, Adjusted risk of ldf mortality as a function of baseline or average prkve diastolic BP categories. BP and secondary outcome. While atorvastatin 80 mg was superior to pravastatin 40 mg in terms of ti the dual goals of aggressive LDL-C and CRP reduction, neither agent brought the majority of patients below thresholds needed to maximize patient benefit.

Author links open overlay panel Paul M. The median triglyceride levels were higher in patients with vs.

Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes. The baseline value was substituted for patients with no downolad data.

In non-diabetic patients, the event rates were 1. Effect of ezetimibe coadministered with atorvastatin in patients with primary hypercholesterolemia: Clinical Perspective on p BP and all-cause mortality.

Published by Elsevier Inc. Relation of reduction in pressure to first myocardial infarction in patients receiving treatment for severe hypertension.

We addressed the relative efficacy of pravastatin 40 mg and atorvastatin 80 mg daily to reduce LDL-C and CRP among 3, acute coronary syndrome patients.

BP values were categorized in mm Hg increments for association with clinical outcomes.