title: Assessing the treatment effect in metabolic syndrome without perceptible diabetes (ATTEMPT): a prospective-randomized study in middle aged men and women.
abstract: OBJECTIVE
  To assess the reduction in estimated cardiovascular disease (e-CVD) risk after multifactorial treatment for 6 months and follow this change during the next 3-years.
  
  
  METHODS
  This prospective, randomized, target driven study included 1,123 subjects (512/611 men/women, aged 45-65 years) with metabolic syndrome (MetS) without diabetes or CVD referred to specialist outpatient clinics. Patients were randomized to two treatment groups: group A with low density lipoprotein cholesterol (LDL-C) target of < 100 mg/dl and group B with a target of < 130 mg/dl. Atorvastatin was used in both groups on top of optimal multifactorial treatment, (quinapril, amlodipine, hydrochlorothiazide for hypertension, metformin for impaired fasting glucose, and orlistat for obesity). The e-CVD risk was calculated using the Framingham, the PROCAM and Reynold's equations.
  
  
  RESULTS
  Reductions in e-CVD risk at 6 months were > 50%in all patients, but were superior in group A and in women. Reductions were even greater during the next 3-years and were mainly attributed to changes in lipid profile. Actual CVD events were 1 in group A and 13 in group B; p=0.0012.
  
  
  CONCLUSIONS
  Attaining the treatment target of LDL-C < 100 mg/dl within multifactorial treatment of MetS by expert clinics, is achievable and beneficial even in patients without diabetes or known CVD. This induces a considerable e-CVD risk reduction in MetS patients. Actual CVD events were negligible, suggesting that e-CVD risk overestimates actual CVD risk in MetS, at least in patients achieving LDL-C < 100 mg/dl [ClinicalTrials.gov ID: NCT00416741].
authors.affiliation: Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Vassilios G
authors.initials: VG
authors.lastname: Athyros
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Ganotakis
authors.forename: Genovefa D
authors.initials: GD
authors.lastname: Kolovou
authors.forename: Vassilios
authors.initials: V
authors.lastname: Nicolaou
authors.forename: Apostolos
authors.initials: A
authors.lastname: Achimastos
authors.forename: Eleni
authors.initials: E
authors.lastname: Bilianou
authors.forename: Theodore
authors.initials: T
authors.lastname: Alexandrides
authors.forename: Asterios
authors.initials: A
authors.lastname: Karagiannis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Paletas
authors.forename: Evangelos N
authors.initials: EN
authors.lastname: Liberopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Petridis
authors.forename: Anna
authors.initials: A
authors.lastname: Kakafika
authors.forename: Moses S
authors.initials: MS
authors.lastname: Elisaf
authors.forename: Dimitri P
authors.initials: DP
authors.lastname: Mikhailidis
mesh_terms: D000368:Aged; D000069059:Atorvastatin; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D011758:Pyrroles / Q000627:therapeutic use*; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin