Skip to main content
Journal cover image

Effects of combination lipid therapy on coronary stenosis progression and clinical cardiovascular events in coronary disease patients with metabolic syndrome: a combined analysis of the Familial Atherosclerosis Treatment Study (FATS), the HDL-Atherosclerosis Treatment Study (HATS), and the Armed Forces Regression Study (AFREGS).

Publication ,  Journal Article
Zhao, X-Q; Krasuski, RA; Baer, J; Whitney, EJ; Neradilek, B; Chait, A; Marcovina, S; Albers, JJ; Brown, BG
Published in: Am J Cardiol
December 1, 2009

We examined the impact of metabolic syndrome (MS) on coronary stenosis progression and major cardiovascular (CV) events and investigated the mitigating effects of low-density lipoprotein (LDL) cholesterol lowering and LDL cholesterol lowering plus high-density lipoprotein (HDL) cholesterol increasing. This analysis combined individual patient data from 445 subjects who participated in 3 double-blinded, randomized, placebo-controlled trials (FATS, HATS, and AFREGS) comparing intensive lipid therapy to placebos on coronary stenosis progression by quantitative coronary angiography and on major CV events. The primary end points were change in mean proximal coronary diameter stenosis (Delta%S(prox)) over 3 years and the frequency of the predefined composite of coronary artery disease death, nonfatal myocardial infarction, stroke, and revascularization due to worsening ischemia. Patients with MS had 50% more rapid coronary stenosis progression and 64% increased CV event frequency compared to those without. More rapid coronary stenosis progression was significantly and independently associated with a 3.5-fold increased event risk (p <0.001). Combination lipid therapy significantly decreased stenosis progression by 83% (Delta%S(prox) 0.5 vs 2.9, p <0.001) in patients with MS and induced a small net regression in those without (Delta%S(prox) -0.3 vs 2.0, p <0.001). Combination therapy decreased the event rate by 54% (13% vs 28%, p = 0.03) in those with MS and by 82% (3% vs 17%, p = 0.002) without. On average, each 10% decrease in LDL cholesterol or 10% increase in HDL cholesterol was significantly associated with a 0.3 Delta%S(prox) decrease. Each 10% decrease in LDL cholesterol or 10% increase in HDL cholesterol was associated with 11% (p = 0.02) or 22% (p <0.001) event risk decrease. In conclusion, patients with MS have significantly more rapid coronary stenosis progression and a higher frequency of CV events. Greater stenosis progression rate is associated with a higher event rate. LDL cholesterol-lowering and HDL cholesterol-increasing therapies independently and significantly decrease coronary stenosis progression and decrease CV events.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

December 1, 2009

Volume

104

Issue

11

Start / End Page

1457 / 1464

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Risk Factors
  • Research Design
  • Randomized Controlled Trials as Topic
  • Military Personnel
  • Middle Aged
  • Metabolic Syndrome
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zhao, Xue-Qiao, Richard A. Krasuski, Jefferson Baer, Edwin J. Whitney, Blazej Neradilek, Alan Chait, Santica Marcovina, John J. Albers, and B Greg Brown. “Effects of combination lipid therapy on coronary stenosis progression and clinical cardiovascular events in coronary disease patients with metabolic syndrome: a combined analysis of the Familial Atherosclerosis Treatment Study (FATS), the HDL-Atherosclerosis Treatment Study (HATS), and the Armed Forces Regression Study (AFREGS).Am J Cardiol 104, no. 11 (December 1, 2009): 1457–64. https://doi.org/10.1016/j.amjcard.2009.07.035.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

December 1, 2009

Volume

104

Issue

11

Start / End Page

1457 / 1464

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Survival Analysis
  • Severity of Illness Index
  • Risk Factors
  • Research Design
  • Randomized Controlled Trials as Topic
  • Military Personnel
  • Middle Aged
  • Metabolic Syndrome
  • Male