Ezetimibe/simvastatine combinatietherapie effectief bij ouderen

Combination therapy with ezetimibe and simvastatin may provide an effective lipid-lowering option for older adults at high- or moderately high risk for coronary heart disease (CHD), research shows.

Previous studies have demonstrated the benefits of ezetimibe combination therapy for patients with dyslipidemia, but there are limited data for patients over 65 years of age.

JoAnne Foody (Harvard Medical School, Boston, Massachusetts, USA) and colleagues say that treatment with ezetimibe/simvastatin causes a greater reduction in low-density lipoprotein (LDL) cholesterol, and a higher attainment of recommended LDL cholesterol levels than treatment with atorvastatin alone, in older adults.

They evaluated data from a multicentre, randomized, double-blind, parallel-group, 12-week study (Vytorin in the Elderly [VYTELD]) of 1289 patients (aged ≥65 years), at high- or moderately high risk for CHD (or with CHD risk equivalents), and with or without atherosclerotic vascular disease (AVD).

Patients were assigned randomly to one of five treatment groups: ezetimibe/simvastatin combination tablet 10/20 or 10/40 mg or atorvastatin 10, 20, or 40 mg. After a 12-week period, patients who received combination therapy had a significantly greater decrease in LDL cholesterol levels than those taking atorvastatin for all dose comparisons, at 54.2% for those taking ezetimibe/simvastatin 10/20 mg compared with 39.5% and 46.6% for those taking atorvastatin 10 and 20 mg, respectively, and 59.1% with ezetimibe/simvastatin 10/40 mg compared with 50.8% with atorvastatin 40 mg.

Significantly more ezetimibe/simvastatin than atorvastatin patients achieved the recommended National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III LDL cholesterol targets for high- and moderately high risk patients (<70 mg/dl; <1.8 mmol/l and <100 mg/dl; 2.6 mmol/l, respectively) for all dose comparisons.

The percentage of patients at high risk for CHD achieving LDL cholesterol <70 mg/dl was 54.3% among those receiving ezetimibe/simvastatin 10/20 mg, compared with 10.9% and 28.9% for those taking atorvastatin 10 and 20 mg, respectively. This target was also achieved by 69.2% of patients taking ezetimibe/simvastatin 10/40 mg, compared with 38.2% of those taking atorvastatin 40 mg.

For intermediate-risk patients, 82.1% achieved LDL cholesterol <100 mg/dl, when receiving combination therapy 10/20 mg, compared with 59.3% on atorvastatin 10 mg.

Writing in the American Journal of Cardiology, the researchers say: "Results from pre-specified subgroup analyses (age, gender, race, diabetes mellitus/metabolic syndrome, baseline LDL cholesterol), were generally similar to those seen with the entire cohort, suggesting the consistent LDL cholesterol-lowering benefit of ezetimibe/simvastatin in these patient populations."

They add that ezetimibe/simvastatin may provide an effective treatment option for dyslipidemia in older patients at high- and moderately high risk for CHD. However, the ultimate effect on cardiovascular disease is awaiting results from ongoing clinical outcome trials.