Statin-ezetimibe combination in hyperlipidemia treatment
Authors:
Tomáš Vařeka; Daniela Vítková; Miroslav Zeman; Marek Vecka; Aleš Žák
Authors place of work:
Univerzita Karlova v Praze, 1. lékařská fakulta, IV. interní klinika VFN
Published in the journal:
Čas. Lék. čes. 2012; 151: 17-21
Category:
Original Article
Summary
Background.
Statin monotherapy for dyslipidemia only rarely achieves recommended target values of plasma lipids. Statin plus ezetimibe is a feasible treatment option. The aim of the present study was to test efficacy and safety of statin plus ezetimibe combination in the treatment of severe dyslipidemia in patients coming to an ordinary lipid and diabetology department.
Methods and results.
A retrospective evaluation of 3 months treatment in 82 dyslipidemia patients (25 male, 57 female) with unsatisfactory statin monotherapy results (average equivalent of 30 mg atorvastatin) was performed. Ezetimibe 10 mg per day was added to preceding treatment. The group included 26 diabetics type 2. The addition of ezetimibe resulted in statistically significant decrease of plasma total cholesterol (TC) (‑21%), LDL-C (-28%), triacylglyceroles (TAG) (-26%) and HDL-C (-6%). The recommended values of LDL-C were achieved in 42% of patients. In the diabetic subgroup a significant decrease of TC (24%), LDL-C (33%) and TAG (18%) was observed. There was no significant decrease of HDL-C. The recommended value of LDL-C was achieved in 48% of diabetics. There were no unfavourable side effects.
Conclusions.
The addition of ezetimib in a dose of 10 mg in hyperlipidaemia patients who had not achieved the recommended target values of LDL-C resulted in a subsequent significant decrease of both TC and LDL-C. It also enabled to increase the number of patients achieving the recommended target plasma lipid values. The treatment was safe and was not associated with adverse effects.
Key words:
hyperlipidaemia, statin, ezetimib, combined hypolipidemic treatment.
Zdroje
1. Rubins HB, Robins SJ, Collins D, et al. Department of Veterans Affairs HDL Intervention Trial Study Group. Distribution of lipids in 8,500 men with coronary artery disease. Am J Cardiol 1995; 75: 1196–1201.
2. 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: 438–445.
3. Grundy SM, Cleeman JI, Bairey-Merz CN, et al. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines, Circulation 2004; 110: 227–239.
4. Vaverková H, Soška V, Rosolová H, et al. Doporučení pro diagnostiku a léčbu dyslipidemií v dospělosti, vypracované výborem České společnosti pro aterosklerózu. Cor Vasa 2007; 49: K73–K86.
5. Nissen SE, Nicholls SJ, Sipahi I, et al. Effect of Very High-Intensity Statin Therapy on Regression of Coronary Atherosclerosis: The ASTEROID Trial. JAMA 2006; 295: 1556–1565.
6. Reiner Z, Amouyel P, De Backer G, et al. Treatment of dyslipidaemia in coronary patients in Europe: improving but still inadequate. Eur Heart J 2008; 29(Suppl.): 761–762.
7. Zeman M, Žák A, Vecka M, Romaniv S. Dlouhodobá kombinační hypolipidemická léčba statiny a fibráty v léčbě smíšené hyperlipidémie. Čas Lék čes 2003; 142: 500–504.
8. Baigent C, Keech A, Kearney PM, et al. Cholesterol Treatment Trialist (CTT) Collaborators. Efficacy and safety of cholesterol lowering treatment: Prospective meta-analysis of data from 90,056 participants in 14 randomized trials of statins. Lancet 2005; 366: 1267–1278.
9. Costa J, Borges M, David C, Vaz Carneiro A. Efficacy o f lipid lowering drug treatment for diabetic and non-diabetic patients: meta-analysis of randomized controlled trials. BMJ 2006; 332: 1115–1124.
10. Garcia-Calvo M, Lisnock J, Bull HG, et al. The target of ezetimibe is Niemann-Pick C1-Like 1 (NPC1L1). Proc Natl Acad Sci USA 2005; 102: 8132–8137.
11. Bays H. Ezetimibe. Expert Opin Investig Drugs 2002; 11: 1587–1604.
12. Simons LA, Symons J. Ezetimibe added to statin therapy (EASY study) - an evaluation by Australian general practitioners. Aust Fam Physician 2007; 36: 90–92, 96.
13. Davidson MH, McGarry T, Bettis R, et al. Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia. J Am Coll Cardiol 2002; 40: 2125–2134.
14. Ballantyne CM, Abate N, Yuan Z, et al. Dose-comparison study of the combination of ezetimibe and simvastatin (Vytorin) versus atorvastatin in patients with hypercholesterolemia: the Vytorin Versus Atorvastatin (VYVA) study. Am Heart J 2005; 149: 464–473.
15. Ballantyne CM, Blazing MA, King TR, et al. Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia. Am J Cardiol 2004; 93: 1487–1494.
16. Pearson TA, Denke EA, McBride PE, et al. Community-Based, Randomized Trial of Ezetimibe Added to Statin Therapy to Attain NCEP ATP III Goals for LDL Cholesterol in Hypercholesterolemic Patients:The Ezetimibe Add-On to Statin for Effectiveness (EASE) Trial. Mayo Clin Proc 2005; 80: 587–595.
17. Ballantyne CM, Weiss R, Moccetti T, et al. EXPLORER Study Investigators. Efficacy and safety of rosuvastatin 40 mg alone or in combination with ezetimibe in patients at high risk of cardiovascular disease (results from the EXPLORER study). Am J Cardiol 2007; 99: 673–680.
18. Stein EA, Ballantyne CM, Windler E, et al. Efficacy and tolerability of fluvastatin XL 80 mg alone, ezetimibe alone, and the combination of fluvastatin XL 80 mg with ezetimibe in patients with a history of muscle-related side effects with other statins. Am J Cardiol 2008; 101: 490–496.
19. 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; 63: 547–559.
20. Goldberg RB, Guyton JR, Mazzone T, et al. Ezetimibe/simvastatin vs atorvastatin in patients with type 2 diabetes mellitus and hypercholesterolemia: the VYTAL study. Mayo Clin Proc 2006; 81: 1579–1588.
21. Constance C, Westphal S, Chung N, et al. Efficacy of ezetimibe/simvastatin 10/20 and 10/40 mg compared with atorvastatin 20 mg in patients with type 2 diabetes mellitus. Diabetes Obes Metab 2007; 9: 575–584.
22. 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: 685–694.
23. Ruggenenti P, Cattaneo D, Rota S, et al. Ezetimibe and Simvastatin in Dyslipidemia of Diabetes (ESD) Study Group. Effects of combined ezetimibe and simvastatin therapy as compared with simvastatin alone in patients with type 2 diabetes: a prospective randomized double-blind clinical trial. Diabetes Care 2010; 33: 1954–1956.
24. Berneis K, Rizzo M, Berthold HK, et al. Ezetimibe alone or in combination with simvastatin increases small dense low-density lipoproteins in healthy men: a randomized trial. Eur Heart J 2010; 31: 1633–1639.
25. Azar RR, Badaoui G, Sarkis A, et al. Effect of ezetimibe/atorvastatin combination on oxidized low density lipoprotein cholesterol in patients with coronary artery disease or coronary artery disease equivalent. Am J Cardiol 2010; 106: 193–197.
26. RossebŅ AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 2008; 359: 1343–1356.
27. Peto R, Emberson J, Landray M, et al. Analyses of Cancer Data from Three Ezetimibe Trials. N Engl J Med 2008; 359: 1357–1366.
28. Ahmed MH. Ezetimbe as potential treatment for cholesterol gallstones: the need for clinical trials. World J Gastroenterol 2010; 16: 1555–1557.
29. Wang HH, Portincasa P, Mendez-Sanchez N, et al. Effect of ezetimibe on the prevention and dissolution of cholesterol gallstones. Gastroenterology 2008; 134: 2101–2110.
30. Ahmed MH, Byrne CD. Ezetimibe as a potential treatment for non-alcoholic fatty liver disease: is the intestine a modulator of hepatic insulin sensitivity and hepatic fat accumulation? Drug Discov Today 2010; 15: 590–595.
31. Muraoka T, Aoki K, Iwasaki T, et al. Ezetimibe decreases SREBP-1c expression in liver and reverses hepatic insulin resistance in mice fed a high-fat diet. Metabolism 2011; 60: 617–628.
32. Yang SJ, Choi JM, Kim L, et al. Chronic administration of ezetimibe increases active glucagon-like peptide-1 and improves glycemic control and pancreatic beta cell mass in a rat model of type 2 diabetes. Biochem Biophys Res Commun 2011; 407: 153–157.
33. Howard BV, Roman MJ, Devereux RB, et al. Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes: the SANDS randomized trial. JAMA 2008; 299: 1678–1689.
34. Fleg JL, Mete M, Howard BV, et al. Effect of statins alone versus statins plus ezetimibe on carotid atherosclerosis in type 2 diabetes: the SANDS (Stop Atherosclerosis in Native Diabetics Study) trial. J Am Coll Cardiol 2008; 52: 2198–2205.
35. Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia, N Engl J Med 2008; 358: 1431–1443.
36. Sharma M, Ansari MT, Abou-Setta AM, et al. Systematic Review: Comparative effectivenessand harms of combination therapy and monotherapy for dyslipidemia. Ann Intern Med 2009; 151: 622–630.
Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
Journal of Czech Physicians
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Advances in the Treatment of Myasthenia Gravis on the Horizon
- Metamizole vs. Tramadol in Postoperative Analgesia
- Spasmolytic Effect of Metamizole
- What Effect Can Be Expected from Limosilactobacillus reuteri in Mucositis and Peri-Implantitis?
Najčítanejšie v tomto čísle
- The history of medicine in the ancient time
- Catheter related blood stream infections – prevalence and interventions
- Statin-ezetimibe combination in hyperlipidemia treatment
- Endoscopy simulator for training in digestive endoscopy