Association between the changes in renal function and serum uric acid levels during multifactorial intervention and clinical outcome in patients with metabolic syndrome. A post hoc analysis of the ATTEMPT study

被引：72

作者：

Athyros, Vassilios G. ^{[2
]}

Karagiannis, Asterios ^{[2
]}

Ganotakis, Emmanouel S. ^{[3
]}

Paletas, Konstantinos ^{[4
]}

Nicolaou, Vassilios ^{[5
]}

Bacharoudis, George ^{[6
]}

Tziomalos, Konstantinos ^{[7
]}

Alexandrides, Theodore ^{[8
]}

Liberopoulos, Evangelos N. ^{[9
]}

Mikhailidis, Dimitri P. ^{[1
]}

机构：

[1] UCL, Sch Med, Dept Clin Biochem, London NW3 2QG, England

[2] Aristotle Univ Thessaloniki, Sch Med, Propedeut Dept Internal Med 2, GR-54006 Thessaloniki, Greece

[3] Univ Crete, Sch Med, Dept Internal Med, Iraklion, Greece

[4] Aristotle Univ Thessaloniki, Sch Med, Dept Internal Med 2, GR-54006 Thessaloniki, Greece

[5] Red Cross Hosp, Cardiol Dept 1, Athens, Greece

[6] Primary Prevent Unit Alexandroupolis, Alexandroupolis, Greece

[7] Aristotle Univ Thessaloniki, Sch Med, Propedeut Dept Internal Med 1, GR-54006 Thessaloniki, Greece

[8] Univ Patras, Sch Med, Rio Hosp, Dept Internal Med,Div Endocrinol, GR-26110 Patras, Greece

[9] Univ Ioannina, Sch Med, Dept Internal Med, GR-45110 Ioannina, Greece

来源：

CURRENT MEDICAL RESEARCH AND OPINION | 2011年 / 27卷 / 08期

关键词：

Cardiovascular events; Metabolic syndrome; Multifactorial treatment; Renal function; Serum uric acid; CORONARY-HEART-DISEASE; CHRONIC KIDNEY-DISEASE; BLOOD-PRESSURE; GREEK ATORVASTATIN; SUBGROUP ANALYSIS; CARDIOVASCULAR OUTCOMES; UNTREATED DYSLIPIDEMIA; INDEPENDENT PREDICTOR; HIGH-RISK; PROGRESSION;

D O I：

10.1185/03007995.2011.595782

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

Aim: To assess the effects of long-term multifactorial intervention on renal function and serum uric acid (SUA) levels and their association with estimated cardiovascular disease (eCVD) risk and actual CVD events. Methods: This prospective, randomized, target-driven study included 1123 subjects (45.6% men, age 45-65 years) with metabolic syndrome (MetS) but without diabetes or CVD. Patients were randomized to multifactorial treatment. Atorvastatin was titrated from 10-80 mg/day aiming at a low density lipoprotein cholesterol (LDL-C) target of <100 mg/dl (group A) or an LDL-C target of <130 mg/dl (group B). Changes in estimated glomerular filtration rate (eGFR) and SUA levels were recorded in all patients and in the subgroup with stage 3 chronic kidney disease (CKD; eGFR = 30-59 ml/min/1.73 m(2); n = 349). We used ANOVA to compare changes within the same group, unpaired Student t-test to compare results between groups at specific time points, and log-rank test to compare event free survival. Results: The eCVD-risk reduction was greater in group A. In the overall study population, eGFR increased by 3.5% (p<0.001) and SUA levels fell by 5.6% (p<0.001). In patients from group A with stage 3 CKD (group A1; n = 172), eGFR increased by 11.1% (p<0.001) from baseline and by 7.5% (p<0.001) in group B1 (n = 177; p<0.001 vs. the change in group A1). The corresponding fall in SUA levels was 10.7% in group A1 (p<0.001 vs. baseline) and 8.3% in group B1 (p<0.001 vs. baseline and group A1). These changes were mainly attributed to atorvastatin treatment. Among the CKD stage 3 patients there were no CVD events in group A1, while 6 events occurred in group B1 (p = 0.014). Conclusions: Multifactorial intervention in patients with MetS without established CVD improved renal function and reduced SUA levels. These changes were more prominent in stage 3 CKD patients and might have contributed to the reduction in eCVD risk and clinical events.

引用

页码：1659 / 1668

页数：10

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