Safety and impact in cardio vascular events of long-term multifactorial treatment in patients with metabolic syndrome and abnormal liver function tests: a post hoc analysis of the randomised ATTEMPT study

被引:90
作者
Athyros, Vassilios G. [2 ]
Giouleme, Olga [3 ]
Ganotakis, Emmanouel S. [4 ]
Elisaf, Moses [5 ]
Tziomalos, Konstantinos [4 ]
Vassiliadis, Themistoklis [4 ]
Liberopoulos, Evangelos N. [1 ]
Theocharidou, Eleni [6 ,7 ]
Karagiannis, Asterios [2 ]
Mikhailidis, Dimitri P. [1 ]
机构
[1] UCL, Dept Clin Biochem, Sch Med, London NW3 2QG, England
[2] Aristotle Univ Thessaloniki, Sch Med, Hippocrat Hosp, Propedeut Dept Internal Med 2, GR-54006 Thessaloniki, Greece
[3] Aristotle Univ Thessaloniki, Sch Med, Div Gastroenterol, Propedeut Dept Internal Med 1, GR-54006 Thessaloniki, Greece
[4] Univ Crete, Sch Med, Dept Internal Med, Iraklion, Greece
[5] Univ Ioannina, Sch Med, Dept Internal Med, GR-45110 Ioannina, Greece
[6] Royal Free Hampstead NHS Trust, Royal Free Hosp, Royal Free Sheila Sherlock Liver Ctr, London, England
[7] UCL, London, ON, Canada
关键词
non-alcoholic fatty liver disease; metabolic syndrome; multifactorial treatment; atorvastatin; cardiovascular disease; ANGIOTENSIN-RECEPTOR BLOCKERS; CORONARY-HEART-DISEASE; FATTY LIVER; NONALCOHOLIC STEATOHEPATITIS; CARDIOVASCULAR EVENTS; OBESE-PATIENTS; GENERAL-POPULATION; THERAPY; ATORVASTATIN; ORLISTAT;
D O I
10.5114/aoms.2011.25554
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of metabolic syndrome (MetS), is common and accounts for 80% of cases of elevated liver function tests (LFTs). We assessed the long-term effects of multifactorial intervention on LFTs and their association with cardiovascular disease (CVD) events in patients with MetS without diabetes mellitus or CVD. Material and methods: This prospective, randomized, open label study included 1,123 patients (aged 45-65 years). Patients received intensive lifestyle intervention and pharmacotherapy: atorvastatin in all patients (low density lipoprotein cholesterol [LDL-C] targets of < 100 mg/dl [group A] or < 130 mg/dl [group B]), inhibitors of the renin-angiotensin-aldosterone axis for hypertension, metformin for dysglycaemia and orlistat for obesity. Results: Among participants, 326 had modestly elevated LFTs and ultrasonographic (US) evidence of NAFLD (165 patients in group A2 and 161 patients in group B2). The NAFLD resolved during the 42-month treatment period in 86% of patients in group A2 and in 74% of patients in group B2 (p < 0.001). In both groups nearly 90% of patients attained lipid goals. Mean LDL-C and TG levels were higher in group B2 than in group A2 (p < 0.001). There were no CVD events in group A2 whereas 5 non-fatal events occurred in group B2 (log-rank-p = 0.024). There were no major side-effects. Conclusions: Attaining multiple treatment targets is safe and beneficial in primary prevention patients with MetS and NAFLD. Lipid levels and LFTs normalized, US findings associated with NAFLD resolved and no CVD events occurred in patients with LDL-C levels < 100 mg/dl (group A2). Resolution of NAFLD might have contributed to the prevention of CVD events.
引用
收藏
页码:796 / 805
页数:10
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