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Abstract
Objective
Statins are known to prevent only 30–50% of cardiovascular disease(CVD) by reducing low-density lipoprotein cholesterol (LDL-C). There is a controversy about whether metabolic syndrome(MS) can increase the risk of CVD. The aim of 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) by reviewing 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 risk of 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 high risk patients who reached LDL-C goal (<100 mg/dL). The patients with MS revealed significantly higher rates of CVD events [p=0.015; hazard ratio (HR) 3.033; 95% confidence interval (CI) 1.184–7.768]. Significantly higher rates of CVD events 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 CVD events [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] and total cholesterol level after statin therapy [p=0.024; HR 0.978; 95% CI 0.959–0.997] as independent predictors of CVD among LDL-C goal achieved patients.
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Fig. 1.
Survival analysis of CVD events stratified by MS (A) or CVD history (B). MS; metabolic syndrome, CVD; Cardiovascular disease
Table 1.
Demographic characteristics and CVD risk factors at baseline
Table 2.
Changes of clinical parameters from baseline to follow-up
Values are expressed as mean±SD (standard deviation) or number (%)
BMI; body mass index (kg/m2), FBS; fasting blood sugar (mg/dL), SBP; systolic blood pressure (mmHg), DBP; diastolic blood pressure (mmHg), TC; total cholesterol (mg/dL), HDL-C; high-density lipoprotein cholesterol (mg/dL), LDL-C; low-density lipoprotein cholesterol (mg/dL), nonHDL-C; non-high density lipoprotein cholesterol (mg/dL)
p values were obtained by paired t-test
Table 3.
LDL cholesterol goal achievement and major cardiovascular events
Table 4.
Metabolic syndrome; the prevalence and distribution of diagnostic criteria
| Total (n=909) | Men (n=467) | Women (n=442) | p value | ||
|---|---|---|---|---|---|
| Metabolic syndrome (+) | Dx criteria ≥3 | 671 (73.8%) | 324 (69.4%) | 347 (78.5%) | 0.002 |
| DX CRITERIA FOR MS | |||||
| Body mass index | ≥25 kg/m2 | 450 (49.5%) | 225 (48.2%) | 225 (50.9%) | 0.411 |
| Triglyceride* | ≥150 mg/dL | 508 (55.9%) | 264 (56.5%) | 244 (55.2%) | 0.687 |
| HDL-C | (Men<40, Women<50 mg/dL) | 400 (44.0%) | 141 (30.2%) | 259 (58.6%) | 0.000 |
| Blood pressure* | ≥130/85 mmHg | 749 (82.4%) | 374 (80.1%) | 375 (84.8%) | 0.060 |
| Fasting blood glucose* | ≥100 mg/dL | 813 (82.9%) | 406 (86.9%) | 407 (92.1%) | 0.012 |
Table 5.
Demographic profiles by diagnostic criteria for metabolic syndrome
Values are expressed as mean±SD (standard deviation) or number (%)
MS; metabolic syndrome, BMI; body mass index (kg/m2), FBS; fasting blood sugar (mg/dL), SBP; systolic blood pressure (mmHg), DBP; diastolic blood pressure (mmHg), TC; total cholesterol (mg/dL), HDL-C; high-density lipoprotein cholesterol (mg/dL), LDL-C; low-density lipoprotein cholesterol (mg/dL), nonHDL-C; non-high density lipoprotein cholesterol (mg/dL)
p values were obtained by paired t-test
Table 6.
Metabolic syndrome and major CVD events
Table 7.
Cox regression analysis for CVD risks among LDL-C goal achieved patients
Variable(s) Entered at Step Number 1: Sex, Smoking history, BMI, Hypertension, Diabetes history, CVD history, antiplatelet agent, MS, CVD 10yr-risk, LDL-C goal achievement, Basal TC, Basal HDL-C, Basal TG, Basal LDL-C, Basal nonHDL-C, F/U TC, F/U HDL-C, F/U TG, F/U LDL-C, F/U nonHDL-C
LDL-C; low density lipoprotein cholesterol, CVD; Cardiovascular disease, MS; metabolic syndrome, TC; total cholesterol, BMI; body mass index, HDL-C; high-density lipoprotein cholesterol, TG; triglyceride, F/U; follow up
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