Relation of characteristics of metabolic syndrome to short-term prognosis and effects of intensive statin therapy after acute coronary syndrome: an analysis of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial.
OBJECTIVE
We examined relations between characteristics of the metabolic syndrome, early cardiovascular risk, and effect of early, intensive statin therapy after acute coronary syndrome.


METHODS
A total of 3,038 patients in the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) trial were characterized by the presence or absence of a history of diabetes, a history of hypertension and/or blood pressure > or = 130/> or = 85, BMI >30 kg/m2, HDL cholesterol <40 mg/dl (men) or <50 mg/dl (women), and triglycerides > or = 150 mg/dl. Patients with three or more of these characteristics were categorized as having metabolic syndrome.


RESULTS
A total of 38% of patients (n = 1,161) met criteria for metabolic syndrome as defined in this study and had a 19% incidence of a primary end point event (death, nonfatal myocardial infarction, cardiac arrest, or recurrent unstable myocardial ischemia) during the 16-week trial. Patients with two or fewer characteristics (n = 1,877) were classified as not having metabolic syndrome and had a 14% incidence of a primary end point event. In univariate analysis, the individual characteristics that bore a significant relation to risk were diabetes and low HDL cholesterol. In a multivariable model including age, sex, and randomized treatment assignment, presence of metabolic syndrome was associated with a hazard ratio of 1.49 (95% CI 1.24-1.79, P < 0.0001). Relative risk reduction with 80 mg atorvastatin daily compared with placebo was similar in patients with and without metabolic syndrome.


CONCLUSIONS
Metabolic syndrome, as defined in the context of this clinical trial, is a strong predictor of early recurrent ischemic events after acute coronary syndrome.
Schwartz
Gregory G
GG
Cardiology Section, VA Medical Center, Denver, Colorado 80220, USA. gregory.schwartz@med.va.gov
Olsson
Anders G
AG
Szarek
Michael
M
Sasiela
William J
WJ
D000208:Acute Disease; D000368:Aged; D000069059:Atorvastatin; D003327:Coronary Disease / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000188:drug therapy* / Q000453:epidemiology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000453:epidemiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011758:Pyrroles / Q000627:therapeutic use*; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin