Metabolic Syndrome Causes Cardiovascular Disease under Stable Statin Medication
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Objective: Statins are known to prevent only 30-50% of cardiovascular disease(CVD) by reducing low-density lipoproteincholesterol (LDL-C). There is a controversy about whether metabolic syndrome(MS) can increase the risk of CVD. The aimof this study is to investigate whether MS can increase the risk of CVD, even after LDL-C is ideally controlled by taking statins. Methods: As a retrospective observational study, we investigated CVD events of 909 patients (61.3±10.2 years old) byreviewing medical records for at least 1 year before and after taking statins respectively, from June 2005 to February 2008,and analyzed the risk factors of CVD. Results: During the study period (881.4±232.8 days), 46 cases of CVD events occurred in patients with a very high riskof CVD and in patients with a high risk of CVD. In patients with a very high risk of CVD, 56.8% (21 cases over 37)of CVD events occurred in patients who achieved LDL-C goal (<70 mg/dL). A total of 9 events developed among highrisk patients who reached LDL-C goal (<100 mg/dL). The patients with MS revealed significantly higher rates of CVDevents [p=0.015; hazard ratio (HR) 3.033; 95% confidence interval (CI) 1.184-7.768]. Significantly higher rates of CVDevents were also found in subgroup analysis of the patient with a past history of CVD events [p=0.017; HR 3.431; 95%CI 1.183-9.956]. Similar pattern was demonstrated in patients with diabetes [p=0.049; HR 2.738; 95% CI 0.963-7.782]. Cox regression analysis identified metabolic syndrome [p=0.025; HR 5.237; 95% CI 1.235-22.204], a past history of CVDevents [p=0.000; HR 5.349; 95% CI 2.321-12.327], basal LDL-C level [p=0.024; HR 1.013; 95% CI 1.002-1.025] andtotal cholesterol level after statin therapy [p=0.024; HR 0.978; 95% CI 0.959-0.997] as independent predictors of CVDamong LDL-C goal achieved patients. Conclusion: Metabolic syndrome is the independent risk factor of CVD events in high risk patients with or without apast history of CVD events or diabetes. In these patients, statins could not prevent CVD events effectively. (J Lipid Atheroscler2017 December;6(2):75-83).
Abstract
Objective: Statins are known to prevent only 30-50% of cardiovascular disease(CVD) by reducing low-density lipoproteincholesterol (LDL-C). There is a controversy about whether metabolic syndrome(MS) can increase the risk of CVD. The aimof this study is to investigate whether MS can increase the risk of CVD, even after LDL-C is ideally controlled by taking statins. Methods: As a retrospective observational study, we investigated CVD events of 909 patients (61.3±10.2 years old) byreviewing medical records for at least 1 year before and after taking statins respectively, from June 2005 to February 2008,and analyzed the risk factors of CVD. Results: During the study period (881.4±232.8 days), 46 cases of CVD events occurred in patients with a very high riskof CVD and in patients with a high risk of CVD. In patients with a very high risk of CVD, 56.8% (21 cases over 37)of CVD events occurred in patients who achieved LDL-C goal (<70 mg/dL). A total of 9 events developed among highrisk patients who reached LDL-C goal (<100 mg/dL). The patients with MS revealed significantly higher rates of CVDevents [p=0.015; hazard ratio (HR) 3.033; 95% confidence interval (CI) 1.184-7.768]. Significantly higher rates of CVDevents were also found in subgroup analysis of the patient with a past history of CVD events [p=0.017; HR 3.431; 95%CI 1.183-9.956]. Similar pattern was demonstrated in patients with diabetes [p=0.049; HR 2.738; 95% CI 0.963-7.782]. Cox regression analysis identified metabolic syndrome [p=0.025; HR 5.237; 95% CI 1.235-22.204], a past history of CVDevents [p=0.000; HR 5.349; 95% CI 2.321-12.327], basal LDL-C level [p=0.024; HR 1.013; 95% CI 1.002-1.025] andtotal cholesterol level after statin therapy [p=0.024; HR 0.978; 95% CI 0.959-0.997] as independent predictors of CVDamong LDL-C goal achieved patients. Conclusion: Metabolic syndrome is the independent risk factor of CVD events in high risk patients with or without apast history of CVD events or diabetes. In these patients, statins could not prevent CVD events effectively. (J Lipid Atheroscler2017 December;6(2):75-83).
참고문헌 (20)
- 노은, "Prevalence and Management of Dyslipidemia in Korea:Korea National Health and Nutrition Examination Survey during 1998 to 2010", Diabetes and Metabolism Journal, 37(6), pp.433~449 (2013), 대한당뇨병학회[DOI]
- Baigent C, "Efficacy and safety of cholesterollowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins", Lancet, 366, pp.1267~1278 (2005)
- Stone NJ, "2013 ACC", AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology, Circulation, pp.2014, 129[DOI]
- Grundy SM, "Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines", Circulation, 110, pp.227~239 (2004)
- Schiele F, "A consensus statement on lipid management after acute coronary syndrome", Eur Heart J Acute Cardiovasc Care (2016)
- Ford ES, "Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey", JAMA, 287, pp.356~359 (2002)
- Hong AR, "Clinical characteristics of metabolic syndrome in Korea, and its comparison with other Asian countries", J Diabetes Investig, 6, pp.508~515 (2015)
- Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group, "Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels", N Engl J Med, 339, pp.1349~1357 (1998)
- Downs JR, "Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS", TexCAPS. Air Force, JAMA, pp.1998, 279[DOI]
- Ridker PM, "Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein", N Engl J Med, 359, pp.2195~2207 (2008)
- Lonn EM, "Blood-pressure lowering in intermediate-risk persons without cardiovascular disease", N Engl J Med, 374, pp.2009~2020 (2016)
- Fedder DO, "New National Cholesterol Education Program III guidelines for primary prevention lipid-lowering drug therapy: projected impact on the size, sex, and age distribution of the treatmenteligible population", Circulation, 105, pp.152~156 (2002)
- Alberti KG, "Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation", Diabet Med, 15, pp.539~553 (1998)
- Goff DC Jr, "2013 ACC", AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology, J Am Coll Cardiol, pp.2014, 63[DOI]
- Ko MJ, "Applicability and potential clinical effects of 2013cholesterol guidelines on major cardiovascular events", Am Heart J, 170, pp.598~605 (2015)
- Jung CH, "The Population-based risk of need for coronary revascularization according to the presence of type 2diabetes mellitus and history of coronary heart disease in the Korean population", PLoS One, 10, pp.e0128627~ (2015)
- An Y, "Cardiovascular and all-cause mortality over a 23-year period among chinese with newly diagnosed diabetes in the Da Qing IGT and Diabetes Study", Diabetes Care, 38, pp.1365~1371 (2015)
- Owen OG, "The collaborative atorvastatin diabetes study:preliminary results", Int J Clin Pract, 59, pp.121~123 (2005)
- National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)., "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report", Circulation, 106, pp.3143~3421 (2002)
- Kim D, "The preventive effects of lifestyle intervention on the occurrence of diabetes mellitus and acute myocardial infarction in metabolic syndrome", Public Health, 139, pp.178~182 (2016)