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Effect of Ezetimibe on LDL-C Lowering and Atherogenic Lipoprotein Profiles in Type 2 Diabetic Patients Poorly

Kentaro Sakamoto1, Mitsunobu Kawamura2, Takahide Kohro3

  • 1Toho University Ohashi Medical Center, Department of Diabetes and Metabolism, Tokyo, Japan.

Plos One
|September 24, 2015
PubMed
Abstract

Insights

Adding ezetimibe to high-potency statin significantly improved LDL-C reduction and atherogenic lipid profiles in type 2 diabetes mellitus (T2DM) patients. This combination therapy is recommended for T2DM patients with insufficient statin response.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • A subpopulation of type 2 diabetes mellitus (T2DM) patients inadequately respond to first-line statin therapy for LDL-C reduction, increasing cardiovascular disease (CVD) risk.
  • Residual risks associated with modified lipid profiles in T2DM require further investigation.

Purpose of the Study:

  • To compare the efficacy of high-potency statin plus ezetimibe (EAT) versus an intensified-dose statin (DST) in T2DM patients with suboptimal LDL-C control.
  • To evaluate the impact of EAT and DST on LDL-C, remnant like particle cholesterol (RLP-C), and small dense LDL cholesterol (sd-LDL-C).

Main Methods:

  • A 12-week, randomized, multicenter, open-label study.
  • Compared 10mg atorvastatin or 1mg pitavastatin plus ezetimibe (EAT) against 20mg atorvastatin or 2mg pitavastatin (DST).
  • Assessed LDL-C reduction, achievement of LDL-C targets, and changes in RLP-C and sd-LDL-C.

Main Results:

  • EAT demonstrated significantly greater LDL-C reduction (-24.6%) compared to DST (-10.9%).
  • EAT significantly reduced sd-LDL-C (-20.5%) and RLP-C (-19.7%) more effectively than DST.
  • 89.4% of patients in the EAT group achieved target LDL-C goals versus 51.0% in the DST group.

Conclusions:

  • Ezetimibe combined with high-potency statin is superior to intensified-dose statin for LDL-C reduction in T2DM patients.
  • This combination therapy improves atherogenic lipid profiles, including sd-LDL-C and RLP-C.
  • Addition of ezetimibe to high-potency statin is recommended as a first-line strategy for T2DM patients with insufficient statin response.

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