Association between the changes in renal function and serum uric acid levels during multifactorial intervention and clinical outcome in patients with metabolic syndrome. A post hoc analysis of the ATTEMPT study (Journal article)

Athyros, V. G./ Karagiannis, A./ Ganotakis, E. S./ Paletas, K./ Nicolaou, V./ Bacharoudis, G./ Tziomalos, K./ Alexandrides, T./ Liberopoulos, E. N./ Mikhailidis, D. P.

AIM: To assess the effects of long-term multifactorial intervention on renal function and serum uric acid (SUA) levels and their association with estimated cardiovascular disease (eCVD) risk and actual CVD events. METHODS: This prospective, randomized, target-driven study included 1123 subjects (45.6% men, age 45-65 years) with metabolic syndrome (MetS) but without diabetes or CVD. Patients were randomized to multifactorial treatment. Atorvastatin was titrated from 10-80 mg/day aiming at a low density lipoprotein cholesterol (LDL-C) target of <100 mg/dl (group A) or an LDL-C target of <130 mg/dl (group B). Changes in estimated glomerular filtration rate (eGFR) and SUA levels were recorded in all patients and in the subgroup with stage 3 chronic kidney disease (CKD; eGFR = 30-59 ml/min/1.73 m(2); n = 349). We used ANOVA to compare changes within the same group, unpaired Student t-test to compare results between groups at specific time points, and log-rank test to compare event free survival. RESULTS: The eCVD-risk reduction was greater in group A. In the overall study population, eGFR increased by 3.5% (p < 0.001) and SUA levels fell by 5.6% (p < 0.001). In patients from group A with stage 3 CKD (group A1; n = 172), eGFR increased by 11.1% (p < 0.001) from baseline and by 7.5% (p < 0.001) in group B1 (n = 177; p < 0.001 vs. the change in group A1). The corresponding fall in SUA levels was 10.7% in group A1 (p < 0.001 vs. baseline) and 8.3% in group B1 (p < 0.001 vs. baseline and group A1). These changes were mainly attributed to atorvastatin treatment. Among the CKD stage 3 patients there were no CVD events in group A1, while 6 events occurred in group B1 (p = 0.014). CONCLUSIONS: Multifactorial intervention in patients with MetS without established CVD improved renal function and reduced SUA levels. These changes were more prominent in stage 3 CKD patients and might have contributed to the reduction in eCVD risk and clinical events. Original study registration number [ ID: NCT00416741].
Institution and School/Department of submitter: Πανεπιστήμιο Ιωαννίνων. Σχολή Επιστημών Υγείας. Τμήμα Ιατρικής
Keywords: Aged,Cardiovascular Diseases/blood/drug therapy/etiology/mortality/physiopathology,Cholesterol, LDL/*blood,Disease-Free Survival,Female,Glomerular Filtration Rate/*drug effects,Heptanoic Acids/*administration & dosage,Humans,Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage,Kidney/*physiopathology,Male,*Metabolic Syndrome X/blood/complications/drug therapy/mortality/physiopathology,Middle Aged,Prospective Studies,Pyrroles/*administration & dosage,Uric Acid/*blood
ISSN: 1473-4877
Appears in Collections:Άρθρα σε επιστημονικά περιοδικά ( Ανοικτά)

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