Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Curr Vasc Pharmacol. 2011 Nov;9(6):647-57. doi: 10.2174/157016111797484080.
To assess the reduction in estimated cardiovascular disease (e-CVD) risk after multifactorial treatment for 6 months and follow this change during the next 3-years.
PATIENTS-METHODS: This prospective, randomized, target driven study included 1,123 subjects (512/611 men/women, aged 45-65 years) with metabolic syndrome (MetS) without diabetes or CVD referred to specialist outpatient clinics. Patients were randomized to two treatment groups: group A with low density lipoprotein cholesterol (LDL-C) target of < 100 mg/dl and group B with a target of < 130 mg/dl. Atorvastatin was used in both groups on top of optimal multifactorial treatment, (quinapril, amlodipine, hydrochlorothiazide for hypertension, metformin for impaired fasting glucose, and orlistat for obesity). The e-CVD risk was calculated using the Framingham, the PROCAM and Reynold's equations.
Reductions in e-CVD risk at 6 months were > 50%in all patients, but were superior in group A and in women. Reductions were even greater during the next 3-years and were mainly attributed to changes in lipid profile. Actual CVD events were 1 in group A and 13 in group B; p=0.0012.
Attaining the treatment target of LDL-C < 100 mg/dl within multifactorial treatment of MetS by expert clinics, is achievable and beneficial even in patients without diabetes or known CVD. This induces a considerable e-CVD risk reduction in MetS patients. Actual CVD events were negligible, suggesting that e-CVD risk overestimates actual CVD risk in MetS, at least in patients achieving LDL-C < 100 mg/dl [ClinicalTrials.gov ID: NCT00416741].
评估 6 个月多因素治疗后估计的心血管疾病（e-CVD）风险降低，并在接下来的 3 年内跟踪这种变化。
患者-方法：这项前瞻性、随机、以目标为导向的研究纳入了 1123 名（512/611 名男性/女性，年龄 45-65 岁）患有代谢综合征（MetS）但无糖尿病或心血管疾病的患者，他们被转诊到专家门诊。患者被随机分为两组：A 组 LDL-C 目标值<100mg/dl，B 组 LDL-C 目标值<130mg/dl。两组均在最佳多因素治疗的基础上加用阿托伐他汀（quinapril、氨氯地平、氢氯噻嗪治疗高血压，二甲双胍治疗空腹血糖受损，奥利司他治疗肥胖）。使用 Framingham、PROCAM 和 Reynold 方程计算 e-CVD 风险。
所有患者在 6 个月时 e-CVD 风险降低>50%，但 A 组和女性患者的降低幅度更大。在接下来的 3 年内，这种降低幅度更大，主要归因于血脂谱的变化。实际发生的 CVD 事件为 A 组 1 例，B 组 13 例；p=0.0012。
通过专家诊所对 MetS 进行多因素治疗，使 LDL-C<100mg/dl 达到治疗目标是可行的，即使在无糖尿病或已知 CVD 的患者中也是有益的。这会使 MetS 患者的 e-CVD 风险显著降低。实际 CVD 事件很少，表明在 MetS 患者中，e-CVD 风险高估了实际 CVD 风险，至少在 LDL-C<100mg/dl 的患者中是这样[ClinicalTrials.gov 注册号：NCT00416741]。
