Safety and impact on cardiovascular 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.
Safety and impact on cardiovascular 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.
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DOI：
10.5114/aoms.2011.25554
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Mikhailidis DP
中科院分区：
文献类型：
--
作者：
Athyros VG;Giouleme O;Ganotakis ES;Elisaf M;Tziomalos K;Vassiliadis T;Liberopoulos EN;Theocharidou E;Karagiannis A;Mikhailidis DP
非酒精性脂肪性肝病（NAFLD）是代谢综合征（MetS）的一种肝脏表现，很常见，占肝功能检查（LFTs）升高病例的80%。我们评估了多因素干预对无糖尿病或心血管疾病（CVD）的代谢综合征患者的肝功能检查以及它们与心血管疾病事件的关联的长期影响。
这项前瞻性、随机、开放标签研究纳入了1123名患者（年龄45 - 65岁）。患者接受强化生活方式干预和药物治疗：所有患者均使用阿托伐他汀（低密度脂蛋白胆固醇[LDL - C]目标为<100 mg/dl[组A]或<130 mg/dl[组B]），肾素 - 血管紧张素 - 醛固酮轴抑制剂用于治疗高血压，二甲双胍用于治疗血糖异常，奥利司他用于治疗肥胖。
在参与者中，326人有轻度升高的肝功能检查结果以及超声（US）显示的非酒精性脂肪性肝病证据（组A2中有165名患者，组B2中有161名患者）。在42个月的治疗期间，组A2中86%的患者和组B2中74%的患者的非酒精性脂肪性肝病得到缓解（p<0.001）。两组中近90%的患者达到了血脂目标。组B2中的平均低密度脂蛋白胆固醇和甘油三酯水平高于组A2（p<0.001）。组A2中无心血管疾病事件发生，而组B2中发生了5起非致命事件（对数秩检验p = 0.024）。无重大副作用。
在患有代谢综合征和非酒精性脂肪性肝病的一级预防患者中，实现多个治疗目标是安全且有益的。血脂水平和肝功能检查恢复正常，与非酒精性脂肪性肝病相关的超声检查结果得到改善，并且低密度脂蛋白胆固醇水平<100 mg/dl的患者（组A2）无心血管疾病事件发生。非酒精性脂肪性肝病的缓解可能有助于预防心血管疾病事件。
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. 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. 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. 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.
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影响因子：
13.5
作者：
BELLENTANI, S;TIRIBELLI, C;SASSATELLI, R
通讯作者：
SASSATELLI, R
影响因子：
2.8
作者：
Athyros, Vassilios G.;Elisaf, Moses S.;Mikhailidis, Dimitri P.
通讯作者：
Mikhailidis, Dimitri P.
影响因子：
7.6
作者：
Angulo, P.
通讯作者：
Angulo, P.
影响因子：
168.9
作者：
Athyros, Vasilios G.;Tziomalos, Konstantinos;Mikhailidis, Dimitri P.
通讯作者：
Mikhailidis, Dimitri P.
影响因子：
4.9
作者：
Garinis, G. A.;Fruci, B.;Belfiore, A.
通讯作者：
Belfiore, A.