Patients with or without the metabolic syndrome had similar reductions in CVD events. The TNT study included 10001 patients with clinically evident coronary heart disease.658 Treating to an LDL cholesterol substantially <100 mg/dL Meschia et al Guidelines for the Primary Prevention of Stroke 3789 with a high dose of a high-potency statin reduced both stroke and cardiovascular events by an additional 20% to 25% com- pared with a lower dose. Of these subjects, 5584 patients with the metabolic syndrome were randomly assigned to high- or As expected, the higher dose led to greater reductions in LDL cholesterol (73 versus 99 mg/dL at 3 months). Regardless of treatment assignment, more patients with the metabolic syndrome (11.3%) had a major cardio- vascular event than those without the metabolic syndrome follow-up of 4.9 years, major cardiovascular events occurred in 13% patients receiving the low-dose statin compared with 9.5% receiving the higher dose (HR, 0.71; 95% CI, 0.61 0.84; P<0.0001), and cardiovascular events were reduced by 26% (HR, 0.74; 95% CI, 0.59 0.93; P=0.011). Metabolic Syndrome: Summary and Gaps Individual components of the metabolic syndrome are associ- ated with an increased risk of ischemic stroke and should be treated as appropriate. The specific risk of stroke in people with the metabolic syndrome appears to be higher but remains uncertain, as is the effect of treatment of the syndrome. Metabolic Syndrome: Recommendations 1. Management of individual components of the meta- bolic syndrome is recommended, including lifestyle measures (ie, exercise, appropriate weight loss, proper diet) and pharmacotherapy (ie, medications for BP lowering, lipid lowering, glycemic control, and antiplatelet therapy), as endorsed in other sections of this guideline. (Refer to relevant sections for Class and Levels of Evidence for each recommendation.) 