Targeting vascular risk in patients with metabolic syndrome but without diabetes
Loading...
Date
Authors
Athyros, V. G.
Mikhailidis, D. P.
Papageorgiou, A. A.
Didangelos, T. P.
Peletidou, A.
Kleta, D.
Karagiannis, A.
Kakafika, A. I.
Tziomalos, K.
Elisaf, M. S.
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Type
Type of the conference item
Journal type
peer-reviewed
Educational material type
Conference Name
Journal name
Metabolism
Book name
Book series
Book edition
Alternative title / Subtitle
Description
There are no prospective data on the effect of a multitargeted treatment approach on cardiovascular disease (CVD) risk reduction in nondiabetic patients with metabolic syndrome (MetS). Furthermore, the optimal hypolipidemic drug treatment in these patients remains controversial. In this prospective, randomized, open-label, intention-to-treat, and parallel study, 300 nondiabetic patients with MetS, free of CVD at baseline, were studied for a period of 12 months. Age- and sex-matched subjects without MetS (n = 100) acted as controls. All patients received lifestyle advice and a stepwise-implemented drug treatment of hypertension, impaired fasting glucose, and obesity. For hypolipidemic treatment, the patients were randomly allocated to 3 treatment groups: atorvastatin (n = 100, 20 mg/d), micronized fenofibrate (n = 100, 200 mg/d), and both drugs (n = 100). Clinical and laboratory parameters, including the lipid profile and C-reactive protein (CRP), were assessed at the baseline and at the end of the study. The primary end point was the proportion of patients not having MetS or its component features at the end of the 12-month treatment period. The secondary end points were the difference in 10-year CVD risk (Prospective Cardiovascular Munster risk calculator) and the degree of CRP reduction. By the end of the study, 76% of the patients no longer had MetS, and 46% had only one diagnostic MetS factor. The estimated 10-year (Prospective Cardiovascular Munster) risk of all patients with MetS at baseline was 14.6%. This was reduced in the atorvastatin group to 6.4%, in the fenofibrate group to 9.2%, and in the combination group to 5.5% (P < .0001 for all vs baseline). The 10-year risks of the atorvastatin and combination groups were not different from that of the control group (5.0%). C-reactive protein was significantly reduced in all treatment groups, with the atorvastatin and combination groups having the greatest reduction (65% and 68%, respectively, P < .01 vs the fenofibrate group, 44%). Lipid values were significantly improved in all 3 treatment groups, with those on the combined treatment attaining lipid targets to a greater extent than those in the other 2 groups. A target-driven and intensified intervention aimed at multiple risk factors in nondiabetic patients with MetS substantially offsets its component factors and significantly reduces the estimated CVD risk. The atorvastatin-fenofibrate combination had the most beneficial effect on all lipid parameters and significantly improved their CVD risk status. Atorvastatin and combination treatment were more effective than fenofibrate alone in reducing CRP levels.
Description
Keywords
Aged, Anticholesteremic Agents/*administration & dosage/adverse effects, C-Reactive Protein/metabolism, Diabetes Mellitus/epidemiology, Drug Therapy, Combination, Female, Fenofibrate/administration & dosage/adverse effects, Heptanoic Acids/*administration & dosage/adverse effects, Humans, Hyperlipidemias/*drug therapy/*epidemiology, Hypolipidemic Agents/administration & dosage/adverse effects, Male, Metabolic Syndrome X/*epidemiology, Middle Aged, Obesity/drug therapy/epidemiology, Prevalence, Prospective Studies, Pyrroles/*administration & dosage/adverse effects, Risk Factors, *Risk Reduction Behavior
Subject classification
Citation
Link
http://www.ncbi.nlm.nih.gov/pubmed/16092057
http://ac.els-cdn.com/S0026049505001332/1-s2.0-S0026049505001332-main.pdf?_tid=7dbafef131c13b45d1673825501c1736&acdnat=1333528031_e07a765bcf933515133a4bc6b1b777e8
http://ac.els-cdn.com/S0026049505001332/1-s2.0-S0026049505001332-main.pdf?_tid=7dbafef131c13b45d1673825501c1736&acdnat=1333528031_e07a765bcf933515133a4bc6b1b777e8
Language
en
Publishing department/division
Advisor name
Examining committee
General Description / Additional Comments
Institution and School/Department of submitter
Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής