Deedwania P C, Shepherd J, Breazna A, DeMicco D A
UCSF School of Medicine, Fresno, CA, USA.
University of Glasgow, Glasgow, UK.
Diabetes Obes Metab. 2016 Jan;18(1):56-63. doi: 10.1111/dom.12581.
To investigate the impact of intensive lipid-lowering with high-dose atorvastatin on the cardiovascular risk associated with individual metabolic syndrome components [high body mass index (BMI), elevated triglycerides, low high-density lipoprotein (HDL) cholesterol, hypertension and elevated fasting glucose] in patients with coronary heart disease (CHD).
Patients with clinically evident, stable CHD and low-density lipoprotein (LDL) cholesterol <3.4 mmol/l (130 mg/dl) were randomized to double-blind therapy with atorvastatin 10 mg/day (n = 5006) or 80 mg/day (n = 4995) after an 8-week open-label run-in with atorvastatin 10 mg. The median follow-up was 4.9 years. The impact of individual metabolic syndrome risk factors was tested on the primary endpoint, which was the occurrence of a first major cardiovascular event.
On-treatment LDL cholesterol was 2.6 mmol/l (101 mg/dl) with atorvastatin 10 mg and 2.0 mmol/l (77 mg/dl) with atorvastatin 80 mg. Among patients receiving atorvastatin 10 mg, the presence of each individual metabolic syndrome component significantly increased the risk of major cardiovascular events compared with the absence of each (BMI, p = 0.014; triglycerides, p = 0.006; HDL cholesterol, p = 0.0006; hypertension, p < 0.0001; and fasting glucose p < 0.0001). In patients receiving atorvastatin 80 mg, elevated triglycerides and fasting glucose were no longer significant predictors of major cardiovascular events. The predictive power of hypertension on the risk of major cardiovascular events was reduced in patients treated with atorvastatin 80 mg, although it remained a significant predictor.
Treatment with high-dose atorvastatin to a mean LDL cholesterol level of 2.0 mmol/l (77 mg/dl) considerably attenuated the predictive power associated with three metabolic syndrome components.
研究大剂量阿托伐他汀强化降脂对冠心病（CHD）患者中与个体代谢综合征组分[高体重指数（BMI）、甘油三酯升高、高密度脂蛋白（HDL）胆固醇降低、高血压和空腹血糖升高]相关的心血管风险的影响。
临床诊断为稳定型CHD且低密度脂蛋白（LDL）胆固醇<3.4 mmol/l（130 mg/dl）的患者，在接受10 mg阿托伐他汀8周开放标签导入期治疗后，被随机分为双盲治疗组，分别接受10 mg/天阿托伐他汀治疗（n = 5006）或80 mg/天阿托伐他汀治疗（n = 4995）。中位随访时间为4.9年。在主要终点事件（首次发生重大心血管事件）上测试个体代谢综合征危险因素的影响。
接受10 mg阿托伐他汀治疗时，治疗期间的LDL胆固醇为2.6 mmol/l（101 mg/dl），接受80 mg阿托伐他汀治疗时为2.0 mmol/l（77 mg/dl）。在接受10 mg阿托伐他汀治疗的患者中，与不存在各代谢综合征组分相比，每个个体代谢综合征组分的存在均显著增加了重大心血管事件的风险（BMI，p = 0.014；甘油三酯，p = 0.006；HDL胆固醇，p = 0.0006；高血压，p < 0.0001；空腹血糖，p < 0.0001）。在接受80 mg阿托伐他汀治疗的患者中，甘油三酯升高和空腹血糖不再是重大心血管事件的显著预测因素。在接受80 mg阿托伐他汀治疗的患者中，高血压对重大心血管事件风险的预测能力有所降低，尽管它仍然是一个显著的预测因素。
大剂量阿托伐他汀治疗使平均LDL胆固醇水平降至2.0 mmol/l（77 mg/dl），大大减弱了与三种代谢综合征组分相关的预测能力。
