High-Dose Statins Benefit Patients with CHD and Metabolic Syndrome

Patients with metabolic syndrome have a particularly high risk for major adverse cardiovascular events and derive additional benefit from aggressive lipid-lowering.

In the industry-funded Treating to New Targets study (Journal Watch Cardiology Apr 22 2005), investigators randomized 10,000 patients with clinically evident coronary heart disease (CHD) and LDL-cholesterol levels lower than 130 mg/dL to receive low (10-mg) or high (80-mg) daily doses of atorvastatin. Five years later, patients in the high-dose group had significantly lower LDL levels than the low-dose group (77 mg/dL vs. 101 mg/dL) and experienced significantly fewer adverse cardiovascular events (coronary death, nonfatal myocardial infarction, resuscitated cardiac arrest, or fatal or nonfatal stroke; 8.7% vs. 10.9%). These results suggested that lowering LDL to <100 mg/dL would benefit some patients with CHD — but which ones?

Now, researchers have examined outcomes in a subgroup of 5584 patients with metabolic syndrome (defined as at least three of these criteria: body-mass index 28 kg/m², triglyceride level 150 mg/dL, HDL-cholesterol level 40 mg/dL in men or 50 mg/dL in women, blood pressure 130/85 mm Hg, and fasting glucose level 100 mg/dL).

Patients with metabolic syndrome had a 44% higher risk for adverse cardiovascular events than did other patients. Among the metabolic-syndrome patients, rates of major adverse cardiovascular events were significantly lower with high-dose atorvastatin than with low-dose atorvastatin (9.5% vs. 13%). In contrast, among patients without metabolic syndrome, event rates were about 8% with both doses.

Comment: Among patients with CHD, those with metabolic syndrome have a particularly high risk for major cardiovascular events and derive additional benefit from aggressive lipid lowering. Further studies of this kind are necessary to identify more precisely those patients for whom cardiovascular benefits will outweigh the risks and costs of such intensive treatment.

— Bruce Soloway, MD

Published in Journal Watch October 25, 2006

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