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Baseline characteristics of HPS participants by prior cerebrovascular disease

Baseline characteristics of HPS participants by prior cerebrovascular disease. Baseline lipids (mmol/L) and apolipoproteins (g/L) by prior cerebrovascular disease. Baseline lipids (mg/dL) and apolipoproteins (g/L) by prior cerebrovascular disease. FACTORIAL TREATMENT COMPARISONS.

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Baseline characteristics of HPS participants by prior cerebrovascular disease

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  1. Baseline characteristics of HPS participantsby prior cerebrovascular disease

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

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

  4. FACTORIAL TREATMENT COMPARISONS

  5. HPS: Stroke Incidence SIMVASTATIN PLACEBO Rate ratio & 95% CI (10269) (10267) STATIN better PLACEBO better Type Ischaemic 290 409 Haemorrhagic 51 53 Unknown 103 134 Severity Fatal 96 119 Severe 42 51 Moderate 107 155 Mild 138 189 Unknown 61 71 ALL STROKES 444 585 25% SE 5 reduction (4.3%) (5.7%) (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  6. HPS: STROKE incidence by AGE & SEX Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Age (years) < 65 164 (3.3%) 195 (4.0%) ≥ 65 < 70 110 (4.5%) 154 (6.3%) ≥ 70 170 (5.8%) 236 (8.2%) Sex Male 331 (4.3%) 453 (5.9%) Female 113 (4.4%) 132 (5.2%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  7. HPS: MAJOR VASCULAR EVENT by AGE & SEX Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Age < 65 831 (16.9%) 1091 (22.1%) 65 - 69 512 (20.9%) 665 (27.2%) 70 - 74 548 (23.8%) 620 (27.7%) ³ 75 142 (23.1%) 209 (32.3%) Sex Male 1666 (21.6%) 2135 (27.6%) Female 367 (14.4%) 450 (17.7%) ALL PATIENTS 2033 (19.8%) 2585 (25.2%) 24% SE 3 reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  8. HPS: STROKE by PRIOR DISEASE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Prior coronary disease Yes 265 (4.0%) 347 (5.2%) No 179 (5.0%) 238 (6.7%) Prior cerebrovascular disease Yes 169 (10.3%) 170 (10.4%) No 275 (3.2%) 415 (4.8%) Prior diabetes Yes 149 (5.0%) 193 (6.5%) No 295 (4.0%) 392 (5.4%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  9. HPS: ISCHAEMIC STROKE by PRIOR DISEASE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Prior coronary disease Yes 175 (2.6%) 237 (3.5%) No 115 (3.2%) 172 (4.8%) Prior cerebrovascular disease Yes 100 (6.1%) 122 (7.5%) No 190 (2.2%) 287 (3.3%) Prior diabetes Yes 102 (3.4%) 140 (4.7%) No 188 (2.6%) 269 (3.7%) 30% SE 6 ALL PATIENTS 290 (2.8%) 409 (4.0%) reduction (2P<0.00001wœ4õ) 0.4 0.6 0.8 1.0 1.2 1.4

  10. HPS: MAJOR VASCULAR EVENTS by PRIOR DISEASE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Prior coronary disease Yes 1459 (21.8%) 1841 (27.5%) No 574 (16.1%) 744 (20.8%) Prior cerebrovascular disease Yes 406 (24.7%) 488 (29.8%) No 1627 (18.9%) 2097 (24.3%) Prior diabetes Yes 601 (20.2%) 748 (25.1%) No 1432 (19.6%) 1837 (25.2%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  11. Risk reductions (SE): ProportionalAbsolute/1000P-value Absolute effects on major vascular events and strokes subdivided by prior cerebrovascular disease 20% (6)58 (18)p=0.001 25% (3) 60 (7)p<0.0001 Other event P S Stroke P S Major vascular event (%) Yes No Prior cerebrovascular disease

  12. HPS: STROKE incidence by BASELINE LIPIDS Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better LDL cholesterol (mmol/L) < 3.0 137 (4.0%) 194 (5.7%) ≥ 3.0 < 3.5 108 (4.2%) 155 (6.2%) > 3.5 199 (4.6%) 236 (5.4%) HDL cholesterol (mmol/L) < 0.9 170 (4.7%) 199 (5.6%) ≥ 0.9 < 1.1 115 (4.1%) 166 (5.8%) > 1.1 159 (4.1%) 220 (5.7%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  13. HPS: MAJOR VASCULAR EVENTS by BASELINE LIPIDS Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better LDL cholesterol (mmol/L) < 3.0 598 (17.6%) 756 (22.2%) ≥ 3.0 < 3.5 484 (19.0%) 646 (25.7%) > 3.5 951 (22.0%) 1183 (27.2%) HDL cholesterol (mmol/L) < 0.9 818 (22.6%) 1064 (29.9%) ≥ 0.9 < 1.1 560 (20.0%) 720 (25.1%) > 1.1 655 (17.0%) 801 (20.9%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  14. HPS: STROKE incidence by baselineBLOOD PRESSURE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Diastolic blood pressure (mmHg) < 80 176 (3.9%) 239 (5.2%) ≥ 80 < 90 131 (4.0%) 185 (5.8%) ≥ 90 137 (5.6%) 160 (6.5%) Systolic blood pressure (mmHg) < 140 162 (3.6%) 189 (4.2%) ≥ 140 < 160 121 (3.9%) 169 (5.3%) ≥ 160 161 (6.1%) 226 (8.8%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  15. HPS: MAJOR VASCULAR EVENTS by baselineBLOOD PRESSURE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better DBP (mmHg) < 80 917 (20.4%) 1210 (26.4%) ³ 80 < 90 644 (19.5%) 753 (23.5%) ³ 90 472 (19.2%) 621 (25.1%) SBP (mmHg) < 140 880 (19.4%) 1064 (23.5%) ³ 140 < 160 553 (17.9%) 772 (24.4%) ³ 160 600 (22.7%) 748 (29.2%) ALL PATIENTS 2033 (19.8%) 2585 (25.2%) 24% SE 3 reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  16. HPS: STROKE incidence by TREATED HYPERTENSION and ASPIRIN USE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Treated hypertension Yes 223 (5.3%) 274 (6.5%) No 221 (3.6%) 311 (5.2%) Aspirin Yes 286 (4.4%) 378 (5.8%) No 158 (4.2%) 207 (5.5%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  17. HPS: MAJOR VASCULAR EVENTS by TREATED HYPERTENSION & ASPIRIN USE Baseline SIMVASTATIN PLACEBO Rate ratio & 95% CI feature (10269) (10267) STATIN better PLACEBO better Treated hypertension Yes 942 (22.4%) 1195 (28.1%) No 1091 (18.0%) 1390 (23.1%) Aspirin Yes 1370 (21.1%) 1784 (27.4%) No 663 (17.5%) 801 (21.3%) 24% SE 3 ALL PATIENTS 2033 (19.8%) 2585 (25.2%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  18. HPS : STROKE incidence by YEAR Year of SIMVASTATIN PLACEBO Rate ratio & 95% CI follow-up (10269) (10267) STATIN better PLACEBO better 1 87 (0.8%) 106 (1.0%) 2 81 (0.8%) 132 (1.3%) 3 82 (0.8%) 111 (1.2%) 4 81 (0.9%) 111 (1.2%) 5+ 113 (1.2%) 125 (1.4%) 25% SE 5 ALL PATIENTS 444 (4.3%) 585 (5.7%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  19. HPS: STROKE by YEAR 7 6 Logrank p<0.0001 PLACEBO 5 4 3 Proportion with stroke SIMVASTATIN 2 1 0 0 1 2 3 4 5 6 Years of follow-up Benefit/1000(SE) 2(1) 7(2) 10(2) 13(3) 14(4) 15(10)

  20. Effects on STROKE in major STATIN trials Study STATIN PLACEBO Rate ratio & 95% CI STATIN better PLACEBO better GREACE 9 (1.1%) 17 (2.1%) AFCAPS/TexcAPS 14 (0.4%) 17 (0.5%) Post-CABG 18 (2.7%) 16 (2.4%) GISSI 20 (0.9%) 19 (0.9%) WOSCOPS 46 (1.4%) 51 (1.5%) CARE 52 (2.5%) 76 (3.7%) SSSS 56 (2.5%) 76 (3.4%) ASCOT 89 (1.7%) 121 (2.4%) PROSPER 135 (4.7%) 131 (4.5%) LIPID 169 (3.7%) 204 (4.5%) ALLHAT 209 (4.0%) 231 (4.5%) HPS 444 (4.3%) 585 (5.7%) 21% SE 4 ALL PATIENTS 1261 (3.0%) 1544 (3.6%) reduction (2P<0.00001) 0.4 0.6 0.8 1.0 1.2 1.4

  21. 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 HPS: Conclusions for people with cerebrovascular disease

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