European Heart Journal Advance Access originally published online on April 8, 2005
European Heart Journal 2005 26(13):1314-1320; doi:10.1093/eurheartj/ehi253
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Impact of statins in microalbuminuric subjects with the metabolic syndrome: a substudy of the PREVEND Intervention Trial
1Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Postbus 30001, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
2Department of Internal Medicine, University Medical Center Groningen, University of Groningen, The Netherlands
3Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands
4Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands
Received 19 October 2004; revised 25 February 2005; accepted 3 March 2005; online publish-ahead-of-print 8 April 2005.
* Corresponding author. Tel: +31 50 3612355; fax:+31 50 3614391. E-mail address: c.a.geluk{at}thorax.umcg.nl
See page 1249 for the editorial comment on this article (doi:10.1093/eurheartj/ehi296)
Aims Microalbuminuria frequently clusters with the metabolic syndrome and may identify subjects at increased coronary risk. Statin treatment may reduce the incidence of major adverse cardiac events in subjects with the metabolic syndrome, but evidence is limited. We evaluated the impact of pravastatin treatment on the incidence of major adverse cardiac events in microalbuminuric subjects with the metabolic syndrome.
Methods and results This substudy of the PREVEND Intervention Trial (a randomized, placebo-controlled trial with a 2x2 factorial design) included 864 microalbuminuric subjects, who were randomized to fosinopril 20 mg or matching placebo and pravastatin 40 mg or matching placebo (mean follow-up 46 months). The metabolic syndrome was defined according to the NCEP ATPIII-report. Subjects with or without the metabolic syndrome were characterized by a higher age, male sex, and increased albuminuria. The incidence of major adverse cardiac events in subjects with the metabolic syndrome [9.1%; 95% confidence interval (CI) 6.0–13.0%] was increased vs. those without [3.6%; 95% CI 2.3–5.5%; P=0.007). Pravastatin treatment lowered the incidence of major adverse cardiac events in subjects with the metabolic syndrome after adjustment for age and sex (hazard ratio=0.39; 95% CI 0.17–0.89; P=0.025).
Conclusion This study supports the use of statins in microalbuminuric subjects with the metabolic syndrome to reduce the incidence of major adverse cardiac events.
Key Words: PREVEND • Microalbuminuria • Metabolic syndrome • Clinical trial • Statin
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