More aggressive treatment with statins necessary to lower LDL cholesterol in patients with coronary heart disease and metabolic syndrome

More aggressive treatment with statins is necessary to lower LDL (low-density lipoprotein) cholesterol in patients with coronary heart disease and metabolic syndrome, a syndrome composing of three cardiovascular risk factors according to an online article published today by The Lancet.

The Treating to New Targets (TNT) study was a prospective, double blind, parallel-group trial which was done at 256 sites in 14 countries between 1998 and 2004, with a median followup of 4.9 years. The analysis by Prakash Deedwania and colleagues (University of California, San Francisco, USA) involved 5584 patients with metabolic syndrome and clinically evident coronary heart disease aged 35-75 years.

The patients were randomly assigned to receive either atorvastatin 10mg per day or 80mg per day (aggressive treatment). At 3 months patients on 10mg per day had mean LDL cholesterol concentrations of 2.5 mmol/L, compared with 1.9 mmol/L in the aggressively treated patients. Major cardiovascular events occurred in 13% patients receiving atorvastatin 10mg, compared with 9.5% receiving 80 mg. Irrespective of treatment, significantly more patients with metabolic syndrome (11.3%) had a major cardiovascular event than those without metabolic syndrome (8%). This increased risk was significantly reduced by intensive therapy with atorvastatin 80 mg beyond that achieved with 10 mg. The analysis suggests that the risk of major cardiovascular events increases with the presence of each component of the metabolic syndrome, and patients with diabetes also have a much higher risk.

By focusing aggressive statins therapy (80 mg a day instead of 10 mg a day) on patients with metabolic syndrome or diabetes in a population with stable coronary heart disease, allows the number needed to treat to be reduced significantly, which gains a significant improvement in the cost-effectiveness of high statin dose.

Andre J Scheen states in an accompanying Online/Comment: "The TNT findings suggest that the presence of metabolic syndrome might help select patients who will best benefit from aggressive lipid-lowering therapy".