Abstract 3729: High-Dose Atorvastatin Attenuates Cardiovascular Risk Prediction of the Metabolic Syndrome Components
The relative predictive power of individual components of the metabolic syndrome (MS) likely differs before and after therapy. The current analysis investigates the impact of intensive lipid lowering with high dose atorvastatin (ATV) on the cardiovascular (CV) risk associated with individual components of MS (as defined by NCEP ATP III and modified by AHA/NHLBI) in 10,001 patients with coronary disease in the Treating to New Targets (TNT) study. Patients were randomized to double-blind therapy with 10 mg or 80 mg of ATV following 8 weeks open-label therapy with ATV 10 mg. Median follow-up was 4.9 years. Mean LDL-C during the study was 101 mg/dL in patients receiving ATV 10 mg and 77 mg/dL in those receiving ATV 80 mg. Major CV events occurred in 548 patients (10.9%) receiving ATV 10 mg and 434 (8.7%) receiving ATV 80 mg. In patients treated with ATV 10 mg (n=5006), presence of each individual MS component significantly increased the risk of major CV events compared with the absence of each (BMI P=0.014, triglycerides P=0.006, HDL-C P=0.0006, hypertension P<0.0001, fasting glucose P<0.0001). In patients treated with ATV 80 mg (n=4995), elevated triglycerides (HR=1.06; 95% CI 0.87, 1.29; P=0.56) and fasting glucose (HR=1.16; 95% CI 0.96, 1.40; P=0.13) were no longer significant predictors of major CV events. The predictive power of hypertension on the risk of major CV events was reduced in patients treated with atorvastatin 80 mg, but remained a significant predictor (HR=1.29; 95% CI 1.02, 1.63; P=0.037). Treatment with high dose ATV to a mean LDL-C of 77 mg/dL considerably attenuated the predictive power associated with 3 major components of MS (triglycerides, fasting glucose, blood pressure).