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Comparison of statin plus ezetimibe with double-dose statin on lipid profiles and inflammation markers
Na-Qiong Wu1, Yuan-Lin Guo1, Cheng-Gang Zhu1
1Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No 167 BeiLiShi Road, XiCheng District, Beijing, 100037, China.
Insights
Combination therapy with moderate-dose statin and ezetimibe significantly reduced low-density lipoprotein cholesterol (LDL-C) more effectively than high-dose statin alone in Chinese patients with atherosclerotic cardiovascular diseases (ASCVD). This approach also achieved a higher rate of LDL-C goal attainment.
Area of Science:
- Cardiology
- Pharmacology
- Biochemistry
Background:
- Achieving low-density lipoprotein cholesterol (LDL-C) goals is critical for patients with atherosclerotic cardiovascular diseases (ASCVD) on lipid-lowering therapy.
- The comparative efficacy of ezetimibe-statin combination versus high-dose statin in Chinese ASCVD patients regarding lipid reduction and inflammation is not well-established.
Purpose of the Study:
- To compare the lipid-lowering efficacy and effects on inflammation markers of a combination regimen (atorvastatin 20 mg + ezetimibe 10 mg) versus a double-dose statin regimen (atorvastatin 40 mg) in Chinese patients with ASCVD.
Main Methods:
- A randomized controlled study involving 98 Chinese patients with ASCVD, treatment-naïve to lipid-lowering agents.
- Patients were randomized into two groups: atorvastatin 40 mg/day (A40 group, n=50) or atorvastatin 20 mg/day + ezetimibe 10 mg/day (A20E10 group, n=48).
- Lipid profiles, oxidative low-density lipoprotein cholesterol (ox-LDL), and high-sensitivity C-reactive protein (Hs-CRP) were measured at baseline and week 12.
Main Results:
- The A20E10 group showed significantly lower LDL-C levels at week 12 compared to the A40 group (1.59 ± 0.44 mmol/L vs 1.99 ± 0.56 mmol/L, p=0.001).
- A higher proportion of patients in the A20E10 group achieved their LDL-C goal (79.2% vs 50.0%, p=0.016).
- No significant differences were observed in ox-LDL or Hs-CRP levels between the two groups after 12 weeks of treatment.
Conclusions:
- Combination therapy with moderate-dose atorvastatin and ezetimibe is more effective in reducing LDL-C levels and achieving LDL-C goals than high-dose atorvastatin alone in Chinese ASCVD patients.
- While superior for LDL-C reduction, this combination therapy demonstrated similar effects on inflammation markers (ox-LDL and Hs-CRP) compared to high-dose atorvastatin.
Background:
Achievement of low-density lipoprotein cholesterol (LDL-C) goal is the most important for the patients with atherosclerotic cardiovascular diseases (ASCVD) who received lipid-lowering therapy. It is unclear that whether combination of ezetimibe with statin is superior to double-dose of statin regarding both of the lipid-lowering efficacy and improvement of inflammation in Chinese patients with ASCVD. Therefore, this study was performed to compare the effects of these two regimes on lipid profiles and inflammation markers.
Methods:
In this randomized control study, ninety eight patients with ASCVD, who were naïve to statins or other lipid-lowering agents, were enrolled into the study, and randomly assigned into two groups, A40 group (atorvastatin 40 mg/d, n = 50), A20E10 group (atorvastatin 20 mg/d combined with ezetimibe 10 mg/d, n = 48).The patients were followed up at week 4 and week 12 after treatment. The lipid profiles and oxidative low-density lipoprotein cholesterol (ox-LDL) were measured at the end of study.
Results:
There were no differences in clinical characteristics including lipid, ox-LDL and hypersensitive C reactive protein (Hs-CRP) among groups at baseline. However, the average level of LDL-C was lower in group A20E10 than that in group A40 significantly (1.59 ± 0.44 mmol/L vs 1.99 ± 0.56 mmol/L, p = 0.001) during follow-up at week 12 after treatment. Importantly, the higher rate of achievement of LDL-C goal was attained at group of combination statin with ezetimibe (79.2% in group A20E10 vs 50.0% in group A40, p = 0.016). The difference of the level of ox-LDL between both the groups after 12 weeks treatment had not statistical significance (3.63 ± 1.13 U/L in group A20E10 vs 4.14 ± 1.32 U/L in group A40, p = 0.077).Similarly, the level of Hs-CRP between both the groups after treatment was not significantly different (p > 0.05).
Conclusions:
In this randomized study, the data showed that a combination of moderate statin and ezetimibe achieved more reduction of LDL-C compared to the double-dose statin but similar impact on inflammation markers.
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