Relation of Characteristics of Metabolic Syndrome to Short-Term Prognosis and Effects of Intensive Statin Therapy After Acute Coronary Syndrome

Abstract

OBJECTIVE -We examined relations between characteristics of the metabolic syndrome, early cardiovascular risk, and effect of early, intensive statin therapy after acute coronary syndrome. RESEARCH DESIGN AND METHODS -A total of 3,038 patients in the MyocardialIschemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial were characterized by the presence or absence of a history of diabetes, a history of hypertension and/or blood pressure Ն130/Ն85, BMI Ͼ30 kg/m 2 , HDL cholesterol Ͻ40 mg/dl (men) or Ͻ50 mg/dl (women), and triglycerides Ն150 mg/dl. Patients with three or more of these characteristics were categorized as having metabolic syndrome.RESULTS -A total of 38% of patients (n ϭ 1,161) met criteria for metabolic syndrome as defined in this study and had a 19% incidence of a primary end point event (death, nonfatal myocardial infarction, cardiac arrest, or recurrent unstable myocardial ischemia) during the 16-week trial. Patients with two or fewer characteristics (n ϭ 1,877) were classified as not having metabolic syndrome and had a 14% incidence of a primary end point event. In univariate analysis, the individual characteristics that bore a significant relation to risk were diabetes and low HDL cholesterol. In a multivariable model including age, sex, and randomized treatment assignment, presence of metabolic syndrome was associated with a hazard ratio of 1.49 (95% CI 1.24 -1.79, P Ͻ 0.0001). Relative risk reduction with 80 mg atorvastatin daily compared with placebo was similar in patients with and without metabolic syndrome.CONCLUSIONS -Metabolic syndrome, as defined in the context of this clinical trial, is a strong predictor of early recurrent ischemic events after acute coronary syndrome.

Impact of Metabolic Syndrome on 10-Year Clinical Outcomes Among Patients With Acute Coronary Syndrome

“…21 In the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACLE) trial, patients with ACS and MetS had increased all-cause mortality and an increased rate of reaching the primary endpoint (death, nonfatal MI, cardiac arrest, or recurrent unstable myocardial ischemia) during a 16-week follow-up. 22 Our study differs from others from the following perspectives. This is the first study in which all patients were treated with complete revascularization.…”

Coronary Plaque Vulnerability in Metabolic Syndrome Assessment of Carotid Artery Morphology in Acute Coronary Syndrome

“…In addition to these conservative treatments, however, aggressive treatments might be recommended for secondary prevention of acute cardiovascular events in ACS patients with metabolic syndrome. Previous studies [19][20][21] have shown that lowering of lipid levels with statin therapy could reduce inflammation and stabilize vulnerable coronary plaques, leading to a lower incidence of cardiac events. C-reactive protein and other emerging blood biomarkers have been proposed to optimize risk stratification of vulnerable patients.…”

The Impact of Pravastatin Therapy on Long-Term Outcome in Patients With Metabolic Syndrome Undergoing Complete Coronary Revascularization

“…30 The second message is that pravastatin therapy was associated with an improved long-term outcome even in patients with CAD treated with complete revascularization. Although several studies showed the efficacy of statins in MS patients with evident CAD, [19][20][21] it is not clear whether the patients who enrolled in those studies had undergone coronary revascularization. To the best of our knowledge, there have been no reports involving patients who had significant CAD but who had been treated with coronary revascularization.…”