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Long-Term Incidence of Stroke and Dementia in ASCOT

Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels...

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Autores principales: Whiteley, William N., Gupta, Ajay K., Godec, Thomas, Rostamian, Somayeh, Whitehouse, Andrew, Mackay, Judy, Sever, Peter S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478091/
https://www.ncbi.nlm.nih.gov/pubmed/34192893
http://dx.doi.org/10.1161/STROKEAHA.120.033489
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author Whiteley, William N.
Gupta, Ajay K.
Godec, Thomas
Rostamian, Somayeh
Whitehouse, Andrew
Mackay, Judy
Sever, Peter S.
author_facet Whiteley, William N.
Gupta, Ajay K.
Godec, Thomas
Rostamian, Somayeh
Whitehouse, Andrew
Mackay, Judy
Sever, Peter S.
author_sort Whiteley, William N.
collection PubMed
description Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels. METHODS: Participants with hypertension and ≥3 cardiovascular disease risk factors were randomly allocated to amlodipine- or atenolol-based BP-lowering regimen targeting BP <140/90 mm Hg for 5.5 years. Participants with total cholesterol ≤6.5 mmol/L were also randomly allocated to atorvastatin 10 mg or placebo for 3.3 years. Mean and LDL (low-density lipoprotein) cholesterol, BP, and SD of BP were calculated from 6 months to end of trial. UK participants were linked to electronic health records to ascertain deaths and hospitalization in general and mental health hospitals. Dementia and stroke were ascertained by validated code lists and within-trial ascertainment. RESULTS: Of 8580 UK participants, 7300 were followed up to 21 years from randomization. Atorvastatin for 3.3 years had no measurable effect on stroke (264 versus 272; adjusted hazard ratio [HR], 0.92 [95% CI, 0.78–1.09]; P=0.341) or dementia (238 versus 227; adjusted HR, 0.98 [95% CI, 0.82–1.18]; P=0.837) compared with placebo. Mean total cholesterol was not associated with later stroke or dementia. An amlodipine-based compared with an atenolol-based regimen for 5.5 years reduced stroke (443 versus 522; adjusted HR, 0.82 [95% CI, 0.72–0.93]; P=0.003) but not dementia (450 versus 465; adjusted HR, 0.94 [95% CI, 0.82–1.07]; P=0.334) over follow-up. BP variability (SD mean BP) was associated with a higher risk of dementia (per 5 mm Hg HR, 1.14 [95% CI, 1.06–1.24]; P<0.001) and stroke (HR, 1.21 [95% CI, 1.12–1.32]; P<0.001) adjusted for mean BP. CONCLUSIONS: An amlodipine-based BP regimen reduced the long-term incidence of stroke compared with an atenolol-based regimen but had no measurable effect on dementia. Atorvastatin had no effect on either stroke or dementia. Higher BP variability was associated with a higher incidence of later dementia and stroke.
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spelling pubmed-84780912021-09-29 Long-Term Incidence of Stroke and Dementia in ASCOT Whiteley, William N. Gupta, Ajay K. Godec, Thomas Rostamian, Somayeh Whitehouse, Andrew Mackay, Judy Sever, Peter S. Stroke Clinical Trials Management of stroke risk factors might reduce later dementia. In ASCOT (Anglo-Scandinavian Outcome Trial), we determined whether dementia or stroke were associated with different blood pressure (BP)–lowering regimens; atorvastatin or placebo; and mean BP, BP variability, and mean cholesterol levels. METHODS: Participants with hypertension and ≥3 cardiovascular disease risk factors were randomly allocated to amlodipine- or atenolol-based BP-lowering regimen targeting BP <140/90 mm Hg for 5.5 years. Participants with total cholesterol ≤6.5 mmol/L were also randomly allocated to atorvastatin 10 mg or placebo for 3.3 years. Mean and LDL (low-density lipoprotein) cholesterol, BP, and SD of BP were calculated from 6 months to end of trial. UK participants were linked to electronic health records to ascertain deaths and hospitalization in general and mental health hospitals. Dementia and stroke were ascertained by validated code lists and within-trial ascertainment. RESULTS: Of 8580 UK participants, 7300 were followed up to 21 years from randomization. Atorvastatin for 3.3 years had no measurable effect on stroke (264 versus 272; adjusted hazard ratio [HR], 0.92 [95% CI, 0.78–1.09]; P=0.341) or dementia (238 versus 227; adjusted HR, 0.98 [95% CI, 0.82–1.18]; P=0.837) compared with placebo. Mean total cholesterol was not associated with later stroke or dementia. An amlodipine-based compared with an atenolol-based regimen for 5.5 years reduced stroke (443 versus 522; adjusted HR, 0.82 [95% CI, 0.72–0.93]; P=0.003) but not dementia (450 versus 465; adjusted HR, 0.94 [95% CI, 0.82–1.07]; P=0.334) over follow-up. BP variability (SD mean BP) was associated with a higher risk of dementia (per 5 mm Hg HR, 1.14 [95% CI, 1.06–1.24]; P<0.001) and stroke (HR, 1.21 [95% CI, 1.12–1.32]; P<0.001) adjusted for mean BP. CONCLUSIONS: An amlodipine-based BP regimen reduced the long-term incidence of stroke compared with an atenolol-based regimen but had no measurable effect on dementia. Atorvastatin had no effect on either stroke or dementia. Higher BP variability was associated with a higher incidence of later dementia and stroke. Lippincott Williams & Wilkins 2021-07-01 2021-10 /pmc/articles/PMC8478091/ /pubmed/34192893 http://dx.doi.org/10.1161/STROKEAHA.120.033489 Text en © 2021 The Authors. https://creativecommons.org/licenses/by/4.0/Stroke is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
spellingShingle Clinical Trials
Whiteley, William N.
Gupta, Ajay K.
Godec, Thomas
Rostamian, Somayeh
Whitehouse, Andrew
Mackay, Judy
Sever, Peter S.
Long-Term Incidence of Stroke and Dementia in ASCOT
title Long-Term Incidence of Stroke and Dementia in ASCOT
title_full Long-Term Incidence of Stroke and Dementia in ASCOT
title_fullStr Long-Term Incidence of Stroke and Dementia in ASCOT
title_full_unstemmed Long-Term Incidence of Stroke and Dementia in ASCOT
title_short Long-Term Incidence of Stroke and Dementia in ASCOT
title_sort long-term incidence of stroke and dementia in ascot
topic Clinical Trials
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8478091/
https://www.ncbi.nlm.nih.gov/pubmed/34192893
http://dx.doi.org/10.1161/STROKEAHA.120.033489
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