Achieving the LDL‑cholesterol target levels in clinical practice. Information from the IN-CROSS study.
Authors:
H. Vaverková
Published in the journal:
Kardiol Rev Int Med 2009, 11(2): 83-86
Summary
A number of interventional studies confirmed that reduction in LDL‑cholesterol (LDL‑C) leads to reduction in cardiovascular morbidity. Consequently, LDL‑C cholesterol is considered as the main target for lipid-lowering therapy in all international and national guidelines. The EUROASPIRE III study has shown that, even though nearly 80% of patients are treated with statins in the secondary prevention, the target levels for LDL‑C cholesterol are achieved in about half of these patients. There are several potential ways how to achieve lower LDL‑C levels: 1) increase the dose of the statin used, 2) switch to a more potent statin and 3) use a combined treatment. A number of patients do not tolerate high dose statins either due to the elevated liver enzymes or creatine kinase or due to clinical difficulties without obvious laboratory abnormities. The latter two options are thus often applied. With respect to this, the results of the recent IN-CROSS study are of interest. The IN-CROSS study compared reduction in LDL‑C achieved by switching the high risk patients who did not achieve the target LDL‑C levels on a stable statin dose to either the so far most potent statin rosuvastatin (ROSUVA) at a dose of 10 mg/day or the combined preparation ezetimibe/simvastatin (EZE/SIMVA) 10/20 mg/day. After 6 weeks of treatment, EZE/SIMVA was significantly more effective in decreasing LDL‑C levels than ROSUVA (further 11% reduction in LDL‑C). Administration of EZE/SIMVA led to significantly higher reduction in total cholesterol, non‑HDL‑C and apolipoprotein B. Adverse events rate was comparable in both groups. Significantly more patients achieved target LDL‑C levels < 2.59, < 2.0 and < 1.8 mmol/l with EZE/SIMVA than ROSUVA. The most significant differences in LDL‑C reduction were observed in patients who were on the most potent statin therapy prior to the study. The combined EZE/SIMVA therapy might help in achieving the target LDL‑C levels particularly in patients with inadequate response to statin therapy. The ongoing large studies will provide crucial results with respect to the impact of this therapy on the incidence of cardiovascular events.
Keywords:
ezetimibe – rosuvastatin – dyslipidemia – dual cholesterol inhibition – hypolipidemic drugs
Zdroje
1. LaRosa JC. Low-density lipoprotein cholesterol reduction: the end is more important than the means. Am J Cardiol 2007; 100: 240–242.
2. Baigent C, Keech A, Kearney PM et al. Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: Prospective meta‑anylysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005; 366: 1267–78.
3. Cannon CP, Steinberg BA, Murphy SA et al. Meta‑analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006; 48: 438–45.
4. Cannon CP, Braunwald E, McCabe CH et al. Pravastatin or Atorvastatin Evaluation and Infection Therapy – Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350: 1495–504.
5. LaRosa JC, Grundy SM, Waters DD et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352: 1425–1435.
6. Pedersen TR, Faergeman O, Kastelein JJ et al. High‑dose atorvastatin vs usual dose simvastatin for secondary prevention after myocardial infarction: the IDEAL study; a randomized controlled trial. JAMA 2005; 294: 2437–45.
7. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497.
8. Grundy SM, Cleenam JI, Bairey CN et al. Coordinating Committee of the National Cholesterol Education Program. Implication of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation 2004;110: 227–239.
9. Smith SC Jr, Allen J, Blair SN et al. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006; 113: 2363–2372.
10. Graham I, Atar D, Borch-Johnsen K et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts). Eur Heart J 2007; 28: 2375–2414.
11. Vaverková H, Soška V, Rosolová H et al. Doporučení pro diagnostiku a léčbu dyslipidémií v dospělosti, vypracovaná výborem České společnosti pro aterosklerózu. Vnitř Lék 2007; 53: 181–197.
12. Kotseva K, Wood D, Backer GD et al; on behalf of the EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patiens from 22 European countries. Eur J Cardiovasc Prev Rehabil 2009; 16: 121–137.
13. Jones PH, Davidson MH, Stein EA et al. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses (STELLAR Trial). Am J Cardiol 2003; 92: 152–160.
14. Nissen SE, Nicholls SJ, Sipahi I et al. ASTEROID Investigators. Effect of very high‑intensity statin therapy on regression of coronary atherosclerosis. The ASTEROID trial. JAMA 2006; 295:1556–1565.
15. Ridker PM, Danielson E Fonseca FA et al. JUPITER Study Group. Rosuvastatin to Prevent Vascular Events in Men and Women with Elevated C-Reactive Protein. N Engl J Med 2008; 359: 2195–207.
16. Masana L, Mata P, Gagné C et al; Ezetimibe Study Group. Long‑Term Safety and Tolerability Profiles and Lipid-Modifying Efficacy of Ezetimibe Coadministered with Ongoing Simvastatin Treatment: Multicenter, Randomized, Double-Blind, Placebo-Controlled, 48-Week Extension Study. Clin Ther 2005; 27: 174–184.
17. MSD-SP Limited. Inegy (Ezetimibe/Simvastatin). Hoddesdon, Hertfordshire, UK; MSD-SP Limited, 2008 (package leaflet).
18. Barrios V, Amabile N, Paganelli F et al. Lipid-altering efficacy of switching from atorvastatin 10 mg/day to ezetimibe/simvastatin 10/20 mg/day compared to doubling the dose of atorvastatin in hypercholesterolemic patients with atherosclerosis or coronary heart disease. Int J Clin Pract 2005; 59: 1377–86.
19. Constance C, Westphal S, Chung N et al. Efficacy of ezetimibe/simvastatin 10/20 and 10/40 mg compared with atorvastatin 20 mg in patiens with type 2 diabetes mellitus. Diabetes Obes Metab 2007; 9: 575–584.
20. Reckless JP, Henry P, Pomykaj T et al. Lipid-altering efficacy of ezetimibe/simvastatin 10/40 mg compared with doubling the statin dose in patients admitted to the hospital for a recent coronary event: the INFORCE study. Int J Clin Pract 2008; 62: 539–554.
21. Roeters van Lennep HW, Liem AH, Dunselman PH et al. The efficacy of statin monotherapy uptitration versus switching to ezetimibe /simvastatin: results of the EASEGO study. Curr Med Res Opin 2008; 24: 685–94.
22. AstraZeneca Pharmaceuticals LP. Crestor (Rosuvastatin), Wilmington, DE; AstraZeneca Pharmaceuticals LP, 2008 (prescriber information).
23. Farnier M, Averna M, Missault L et al. Lipid-altering efficacy of ezetimibe/simvastatin 10/20 mg compared with rosuvastatin 10 mg in high risk hypercholesterolaemic patients inadequately controlled with prior statin monotherapy – The IN-CROSS study. Int J Clin Pract 2009 (Epub ahead of print).
Štítky
Paediatric cardiology Internal medicine Cardiac surgery CardiologyČlánok vyšiel v časopise
Cardiology Review
2009 Číslo 2
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