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Pleiotropic effects of ezetimibe/simvastatin vs. high dose simvastatin

Antonio Eduardo P Pesaro1, Carlos V Serrano, Juliano L Fernandes

  • 1Heart Institute, University of Sao Paulo, Av. Enéas de C. Aguiar, 44, Building II, 2nd Floor, Room 12, Sao Paulo, SP 05403-901, Brazil. eduardopesaro@hotmail.com

International Journal of Cardiology
|February 22, 2011
PubMed

Insights

In stable coronary artery disease (CAD), combined ezetimibe/simvastatin (E10/S20) and high-dose simvastatin (S80) similarly reduced LDL-C and had no anti-inflammatory effects. However, E10/S20 demonstrated superior inhibition of platelet aggregation compared to S80.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Atherosclerosis Research

Background:

  • The pleiotropic effects of cholesterol reduction therapies in stable coronary artery disease (CAD) remain incompletely understood.
  • Comparing combined ezetimibe/simvastatin with high-dose simvastatin alone is crucial for understanding differential therapeutic benefits beyond lipid lowering.

Purpose of the Study:

  • To investigate and compare the anti-inflammatory and antiplatelet effects of ezetimibe 10mg/simvastatin 20mg (E10/S20) versus simvastatin 80 mg (S80).
  • To assess whether combined therapy offers distinct advantages over high-dose monotherapy in patients with stable CAD.

Main Methods:

  • A randomized trial involving 83 stable CAD patients, initially on simvastatin 20mg (S20), was conducted over 6 weeks.
  • Participants were assigned to receive either E10/S20 or S80.
  • Changes in lipids, inflammatory markers (including C-reactive protein, IL-6, MCP-1, sCD40L, oxidized LDL), and platelet aggregation (PFA-100) were measured.

Main Results:

  • Both E10/S20 and S80 achieved similar reductions in LDL-C and apo-B levels.
  • Neither treatment regimen showed significant changes in measured inflammatory markers.
  • The E10/S20 group exhibited a significantly greater inhibition of platelet aggregation compared to the S80 group (p=0.02).

Conclusions:

  • In stable CAD patients on S20, both E10/S20 and S80 are equally effective in further reducing LDL-C.
  • Neither treatment demonstrated additional anti-inflammatory effects.
  • Ezetimibe/simvastatin (E10/S20) showed a superior ability to inhibit platelet aggregation compared to high-dose simvastatin (S80), despite a lower simvastatin dose.
Abstract

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