Management of vascular risk factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)

Area of Science:

• Cardiovascular Medicine
• Clinical Trials
• Vascular Surgery

Background:

• The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) evaluated stenting versus endarterectomy for carotid disease.
• This study specifically assessed the management of vascular risk factors within the CREST trial population.

Purpose of the Study:

• To evaluate the effectiveness of site-based management of vascular risk factors in patients undergoing carotid revascularization.
• To determine the degree of improvement and the rate of optimal control for key vascular risk factors over time.

Main Methods:

• Analysis of data from 2210 patients in the CREST trial.
• Biannual monitoring of risk factors including low-density lipoprotein cholesterol, systolic blood pressure, fasting blood glucose, and smoking status.
• Generalized estimating equations used to compare baseline risk factors with follow-up data up to 48 months.

Main Results:

• Significant improvements were observed in the control of low-density lipoprotein cholesterol, systolic blood pressure, fasting blood glucose, and smoking status from baseline to 48 months.
• The percentage of patients achieving optimal risk-factor control (all four goals) increased significantly from 16.7% to 36.2% (P<0.001).
• Despite improvements, approximately two-thirds of participants did not achieve optimal risk-factor control during the study period.

Conclusions:

• Site-based management led to significant improvements in vascular risk factor control in the CREST trial, both short-term and long-term.
• Overall risk factor control, however, remained suboptimal for a majority of patients.
• The findings suggest that more intensive medical management strategies should be considered for future carotid revascularization trials.