Early Effects of Lipid Lowering Treatment in Subjects with Metabolic Syndrome and Acute Coronary Syndromes

Background: Patients with metabolic syndrome are at high-risk for cardiovascular events. This study compared early effects of usual lipid-lowering treatment on several metabolic parameters after an acute coronary syndrome. Methods and results: Patients (n=116) of both sexes with acute cor- onary syndrome and LDL-C <130 mg/dL on hospital admission with metabolic syndrome criteria (NCEP/ATP III) were randomly assigned to double blind 6-wk therapy with atorvastatin 10 mg/day, fenofibrate 200 mg/day, atorvastatin 10 mg/day plus fenofibrate 200 mg/day or placebo, in addition to nutritional counseling based on the therapeutic lifestyle changes. The active drug treatment pro- moted significant changes in lipid profile, however optimal targets for LDL-C, HDL-C, triglycerides, non-HDL-C and ApoB/ApoA1 ratio were achieved only in nearly half of these subjects. At the end of the study, we found lower serum levels of high-sensitivity C-reactive protein, fibrinogen, von Wille - brand factor, D-Dimer, and thiobarbituric acid-reactive species, regardless of treatments. Conclu- sions: In these high-risk patients, partial improvement in several non-lipid risk factors was found to be part of the healing process after acute coronary syndromes, and a more aggressive lipid approach seems necessary for additional benefits and achievement of current lipid goals.