Assessing The Treatment Effect in Metabolic Syndrome Without Perceptible Diabetes (ATTEMPT): A Prospective-Randomized Study in Middle Aged Men and Women

Author(s): Vassilios G. Athyros , Emmanouel Ganotakis , Genovefa D. Kolovou , Vassilios Nicolaou , Apostolos Achimastos , Eleni Bilianou , Theodore Alexandrides , Asterios Karagiannis , Konstantinos Paletas , Evangelos N. Liberopoulos , Konstantinos Tziomalos , Dimitrios Petridis , Anna Kakafika , Moses S. Elisaf , Dimitri P. Mikhailidis .

Journal Name: Current Vascular Pharmacology

Volume 9 , Issue 6 , 2011

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Abstract:

Aim: To assess the reduction in estimated cardiovascular disease (e-CVD) risk after multifactorial treatment for 6 months and follow this change during the next 3-years. Patients-Methods: This prospective, randomized, target driven study included 1,123 subjects (512/611 men/women, aged 45-65 years) with metabolic syndrome (MetS) without diabetes or CVD referred to specialist outpatient clinics. Patients were randomized to two treatment groups: group A with low density lipoprotein cholesterol (LDL-C) target of > 100 mg/dl and group B with a target of < 130 mg/dl. Atorvastatin was used in both groups on top of optimal multifactorial treatment, (quinapril, amlodipine, hydrochlorothiazide for hypertension, metformin for impaired fasting glucose, and orlistat for obesity). The e-CVD risk was calculated using the Framingham, the PROCAM and Reynolds equations. Results: Reductions in e-CVD risk at 6 months were > 50%in all patients, but were superior in group A and in women. Reductions were even greater during the next 3-years and were mainly attributed to changes in lipid profile. Actual CVD events were 1 in group A and 13 in group B; p=0.0012. Conclusions: Attaining the treatment target of LDL-C < 100 mg/dl within multifactorial treatment of MetS by expert clinics, is achievable and beneficial even in patients without diabetes or known CVD. This induces a considerable e-CVD risk reduction in MetS patients. Actual CVD events were negligible, suggesting that e-CVD risk overestimates actual CVD risk in MetS, at least in patients achieving LDL-C < 100 mg/dl [ClinicalTrials.gov ID: NCT00416741].

Keywords: Metabolic syndrome, cardiovascular disease risk, atorvastatin, multifactorial treatment, Framingham, PROCAM, Reynold's, actual events, obesity, low density lipoprotein cholesterol

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Article Details

VOLUME: 9
ISSUE: 6
Year: 2011
Page: [647 - 657]
Pages: 11
DOI: 10.2174/157016111797484080
Price: $58

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