{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T03:15:18Z","timestamp":1780542918179,"version":"3.54.1"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,12,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The Carotid Revascularization Endarterectomy Versus Stenting Trial (\n              <jats:styled-content style=\"fixed-case\">CREST<\/jats:styled-content>\n              ) 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.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Management was provided by the patient's physician, with biannual monitoring results collected by the local site. Therapeutic targets were low\u2010density lipoprotein, cholesterol &lt;100\u00a0mg\/dL, systolic blood pressure &lt;140\u00a0mm\u00a0Hg, fasting blood glucose &lt;126\u00a0mg\/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\u2010up visits for up to 48 months. In the analysis cohort of 2210, significant improvements in risk\u2010factor control were observed across risk factors for all follow\u2010up visits compared with baseline. At 48\u00a0months, achievement of the low\u2010density lipoprotein cholesterol goal improved from 59.1% to 73.6% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), achievement of the systolic blood pressure goal improved from 51.6% to 65.1% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), achievement of the glucose goal improved from 74.9% to 80.7% (\n              <jats:italic>P<\/jats:italic>\n              =0.0101), and nonsmoking improved from 74.4% to 80.9% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). The percentage with optimal risk\u2010factor control also improved significantly, from 16.7% to 36.2% (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001), but nearly 2 of 3 study participants did not achieve optimal control during the study.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Site\u2010based risk\u2010factor control improved significantly in the first 6\u00a0months and over the long term in\n              <jats:styled-content style=\"fixed-case\">CREST<\/jats:styled-content>\n              but was often suboptimal. Intensive medical management should be considered for future trials of carotid revascularization.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Clinical Trial Registration<\/jats:title>\n            <jats:p xml:lang=\"en\">URL: ClinicalTrials.gov. Unique identifier: NCT00004732.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.114.001180","type":"journal-article","created":{"date-parts":[[2014,11,27]],"date-time":"2014-11-27T05:57:01Z","timestamp":1417067821000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":14,"title":["Management of Vascular Risk Factors in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST)"],"prefix":"10.1161","volume":"3","author":[{"given":"James F.","family":"Meschia","sequence":"first","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenifer H.","family":"Voeks","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Medical University of South Carolina, Charleston, SC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre P.","family":"Leimgruber","sequence":"additional","affiliation":[{"name":"Cardiovascular Diseases and Interventional Cardiology, Providence Spokane Heart Institute, Spokane, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vito A.","family":"Mantese","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Mercy Clinic, St. Louis, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H.","family":"Timaran","sequence":"additional","affiliation":[{"name":"Vascular Surgery, University of Texas Southwestern Medical Center\/VA North Texas Care System, Dallas, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Methodist Hospital, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart M.","family":"Demaerschalk","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Scottsdale, AZ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia J.","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, University of Alabama at Birmingham, AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan E.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Surgery, New Jersey Medical School, Rutgers University, Newark, NJ"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Longbottom","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie Green","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, University of North Carolina at Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas 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