Abstract 15283: Metabolic Syndrome and Cardiovascular Events in Statin-Treated Stable Coronary Patients: Prospective Results From the TNT Study
Background: Individuals with the metabolic syndrome (MetS) are at high risk for a major cardiovascular event (MCVE). However, the predictive value of MetS in both statin-treated patients and in the elderly has recently been challenged. Therefore, the Objectives of the present study was to investigate the relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels, MetS and the risk of MCVE after one year of atorvastatin therapy in patients with stable coronary heart disease (CHD) without diabetes.
Methods and Results: We performed a post-hoc analysis in the Treating to New Targets (TNT) study, a double-blind randomized controlled trial in which 10,001 patients with established CHD were assigned to atorvastatin 10 mg or 80 mg. A total of 2622 patients were excluded from this analysis because of prevalent diabetes (n=1397), MCVE during the first year of treatment (n=655) or missing data at year 1 (n=570). Our study sample included 7379 patients among whom 1644 had a MCVE between 1 year of treatment and the end of the follow-up of 4.9 year. At year 1, 2852 patients (38.7%) met the criteria for MetS. Compared to patients without MetS who achieved LDL-C levels <70 mg/dL, those with MetS who achieved LDL-C levels <70 mg/dL had an age-, sex- and smoking-adjusted hazard ratio (HR) for future MCVE of 1.28 (95% CI, 1.02–1.60), those without MetS who did not achieve LDL levels <70 mg/dL had a HR of 1.31 (1.12–1.54) and those with MetS who did not achieve LDL levels <70 mg/dL had a HR of 1.76 (1.50–2.08). Compared to patients aged <65 years without MetS, those aged <65 years with MetS had a sex and smoking-adjusted HR of 1.35 (1.18–1.54), those aged ≥65 years without MetS had a HR of 1.47 (1.29–1.68) and those aged ≥65 years with MetS had a HR of 1.94 (1.68–2.24).
Conclusions: Among statin-treated patients with stable CHD, those with the MetS were at increased risk of having a MCVE, irrespective of achieved LDL-C or age.
- © 2010 by American Heart Association, Inc.