1.
Effects of lipid-altering treatment in diabetes mellitus and the metabolic syndrome.
Deedwania, PC, Hunninghake, DB, Bays, H
The American journal of cardiology. 2004;(11A):18C-26C
Abstract
The metabolic syndrome (MS) poses an increased risk for the development of diabetes mellitus and cardiovascular events. The syndrome typically includes dyslipidemia, characterized by elevated plasma triglycerides and low high-density lipoprotein cholesterol concentrations. Retrospective analyses of coronary artery disease outcomes trials in patient subpopulations with diabetes or the MS indicate that lipid-altering therapies provide benefits for patients with the MS at least as much as observed in patients without diabetes or the MS. Analyses of the effects of lipid-altering therapy on the lipid profile in patients with the MS also indicate that beneficial lipid changes are similar in patients with the MS compared with those in patients without the MS. The benefits of statin treatment in patients with the MS have become increasingly clear, and it is likely that further improvements in treatment may be achieved with newer statins or a combination of lipid-altering drugs. Prospective data from clinical trials examining the preventive effects of lipid-altering therapy in MS patients are needed to better define potential benefits and optimal treatment in this population.
2.
Reduction of cardiovascular events by simvastatin in nondiabetic coronary heart disease patients with and without the metabolic syndrome: subgroup analyses of the Scandinavian Simvastatin Survival Study (4S).
Pyörälä, K, Ballantyne, CM, Gumbiner, B, Lee, MW, Shah, A, Davies, MJ, Mitchel, YB, Pedersen, TR, Kjekshus, J, ,
Diabetes care. 2004;(7):1735-40
Abstract
OBJECTIVE To assess the effect of simvastatin treatment on the risk of cardiovascular events in nondiabetic patients with coronary heart disease (CHD) with and without the metabolic syndrome, as defined by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP-III). RESEARCH DESIGN AND METHODS Subgroup analyses were performed on data from 3933 nondiabetic patients with clinically established CHD, serum total cholesterol level 5.5-8.0 mmol/l, and serum triglyceride level RESULTS Over the 5.4-year median follow-up period, simvastatin produced similar changes in serum lipid levels in 893 patients with the metabolic syndrome and in 3040 patients without the metabolic syndrome. The relative risks of main end points in simvastatin-treated patients compared with placebo-treated patients with the metabolic syndrome were as follows: total mortality 0.54 (95% CI 0.36-0.82), coronary mortality 0.39 (0.23-0.65), major CHD event 0.59 (0.45-0.77), and any atherosclerotic event 0.69 (0.56-0.84). The corresponding RRs in patients without the metabolic syndrome were 0.72 (0.56-0.91), 0.62 (0.45-0.84), 0.71 (0.61-0.82), and 0.76 (0.68-0.85). CONCLUSIONS Nondiabetic CHD patients with or without the metabolic syndrome realize from simvastatin treatment a similar, substantial relative reduction in the risk of cardiovascular events. The absolute benefit may be greater in patients with the metabolic syndrome because they are at a higher absolute risk.
3.
New therapeutic options in the National Cholesterol Education Program Adult Treatment Panel III.
Talbert, RL
The American journal of managed care. 2002;(12 Suppl):S301-7
Abstract
Coronary heart disease (CHD) is a common, costly, and undertreated disorder in the United States, and dyslipidemia is one of its most important modifiable risk factors. Recently, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) published updated guidelines for the treatment of lipid disorders, greatly expanding the number of patients eligible for therapy. In the new recommendations, several significant changes have been made in the identification and management of patients at risk for CHD. Although ATP III maintains that low-density lipoprotein (LDL) cholesterol should be the primary target of lipid-lowering therapy, it identifies non-high-density lipoprotein (HDL) cholesterol (total cholesterol minus HDL cholesterol) as a secondary target in patients with elevated triglycerides. Patients with > or = 2 CHD risk factors should now be assessed for 10-year absolute CHD risk based on the Framingham Point Scale to identify those who require more aggressive treatment. The guidelines also designate a new category, CHD risk equivalent, which recognizes that certain patients have the same high risk as those with established CHD. Diabetes is now identified as a CHD risk equivalent, as are other forms of atherosclerotic disease and multiple risk factors comprising a CHD 10-year risk of > 20%. New lipoprotein classifications are given, and increased emphasis is placed on the metabolic syndrome, a constellation of metabolic risk factors, as a marker for CHD risk. Since adherence poses a major challenge in the management of patients with or at risk for CHD, the new guidelines provide physicians with several strategies for increasing patient compliance. The new guidelines should help physicians better identify and manage patients at risk for CHD, help more patients reach their lipid goals, and thereby decrease cardiovascular morbidity and mortality.