J Lipid Atheroscler.  2017 Dec;6(2):75-83. 10.12997/jla.2017.6.2.75.

Metabolic Syndrome Causes Cardiovascular Disease under Stable Statin Medication

Affiliations
  • 1Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. steadyhan@amc.seoul.kr

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.
CONCLUSION
Metabolic syndrome is the independent risk factor of CVD events in high risk patients with or without a past history of CVD events or diabetes. In these patients, statins could not prevent CVD events effectively.

Keyword

Statin; Cardiovascular disease; Metabolic syndrome

MeSH Terms

Cardiovascular Diseases*
Cholesterol
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors*
Lipoproteins
Medical Records
Observational Study
Retrospective Studies
Risk Factors
Cholesterol
Lipoproteins

Figure

  • Fig. 1. Survival analysis of CVD events stratified by MS (A) or CVD history (B). MS; metabolic syndrome, CVD; Cardiovascular disease


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