| Effects of combination lipid therapy on coronary stenosis progression and clinical cardiovascular events in coronary disease patients with metabolic syndrome: a combined analysis of the Familial Atherosclerosis Treatment Study (FATS), the HDL-Atherosclerosis Treatment Study (HATS), and the Armed Forces Regression Study (AFREGS). | |
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MedLine Citation:
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PMID: 19932775 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We examined the impact of metabolic syndrome (MS) on coronary stenosis progression and major cardiovascular (CV) events and investigated the mitigating effects of low-density lipoprotein (LDL) cholesterol lowering and LDL cholesterol lowering plus high-density lipoprotein (HDL) cholesterol increasing. This analysis combined individual patient data from 445 subjects who participated in 3 double-blinded, randomized, placebo-controlled trials (FATS, HATS, and AFREGS) comparing intensive lipid therapy to placebos on coronary stenosis progression by quantitative coronary angiography and on major CV events. The primary end points were change in mean proximal coronary diameter stenosis (Delta%S(prox)) over 3 years and the frequency of the predefined composite of coronary artery disease death, nonfatal myocardial infarction, stroke, and revascularization due to worsening ischemia. Patients with MS had 50% more rapid coronary stenosis progression and 64% increased CV event frequency compared to those without. More rapid coronary stenosis progression was significantly and independently associated with a 3.5-fold increased event risk (p <0.001). Combination lipid therapy significantly decreased stenosis progression by 83% (Delta%S(prox) 0.5 vs 2.9, p <0.001) in patients with MS and induced a small net regression in those without (Delta%S(prox) -0.3 vs 2.0, p <0.001). Combination therapy decreased the event rate by 54% (13% vs 28%, p = 0.03) in those with MS and by 82% (3% vs 17%, p = 0.002) without. On average, each 10% decrease in LDL cholesterol or 10% increase in HDL cholesterol was significantly associated with a 0.3 Delta%S(prox) decrease. Each 10% decrease in LDL cholesterol or 10% increase in HDL cholesterol was associated with 11% (p = 0.02) or 22% (p <0.001) event risk decrease. In conclusion, patients with MS have significantly more rapid coronary stenosis progression and a higher frequency of CV events. Greater stenosis progression rate is associated with a higher event rate. LDL cholesterol-lowering and HDL cholesterol-increasing therapies independently and significantly decrease coronary stenosis progression and decrease CV events. |
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Authors:
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Xue-Qiao Zhao; Richard A Krasuski; Jefferson Baer; Edwin J Whitney; Blazej Neradilek; Alan Chait; Santica Marcovina; John J Albers; B Greg Brown |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of cardiology Volume: 104 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2009 Dec |
Date Detail:
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Created Date: 2009-11-25 Completed Date: 2010-02-01 Revised Date: 2011-03-03 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1457-64 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Division of Cardiology, University of Washington School of Medicine, Seattle, Washington, USA. xueqiao@u.washington.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Anticholesteremic Agents / therapeutic use* Atherosclerosis / drug therapy*, genetics Biological Markers / blood Body Mass Index Cholesterol, HDL / blood* Cholesterol, LDL / blood Coronary Angiography Coronary Stenosis / blood, complications, diagnosis, drug therapy*, radiography* Disease Progression Double-Blind Method Female Follow-Up Studies Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use Male Metabolic Syndrome X / complications* Middle Aged Military Personnel Randomized Controlled Trials as Topic Research Design Risk Factors Severity of Illness Index Survival Analysis Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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DK 17047/DK/NIDDK NIH HHS; DK 35816/DK/NIDDK NIH HHS; P01 HL30086/HL/NHLBI NIH HHS; R01 HL049546-05/HL/NHLBI NIH HHS; R01 HL19451/HL/NHLBI NIH HHS; R01 HL49546/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anticholesteremic Agents; 0/Biological Markers; 0/Cholesterol, HDL; 0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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