Toevoegen ezetimibe effectief voor behalen lipidenstreefwaarden

Adding ezetimibe to atorvastatin therapy in patients at moderately high risk (MHR) and high risk (HR) for coronary heart disease (CHD) is more likely to achieve treatment targets for hypercholesterolemia compared with doubling the atorvastatin dose, researchers have found.
 

Publishing their findings in the International Journal of Clinical Practice, Lawrence Leiter (University of Toronto, Ontario, Canada) and colleagues demonstrate that MHR and HR patients treated with atorvastatin plus ezetimibe have greater attainment of targets for low-density lipoprotein (LDL) cholesterol, most lipids and lipoproteins, and high sensitivity C-reactive protein (hs-CRP), compared with those doubling their atorvastatin dose.
 

In this post hoc analysis, Leiter's team studied 775 patients aged 18-80 years at risk for CHD, who were treated with atorvastatin for 4 weeks. Of these patients, 196 patients were at MHR for CHD (LDL cholesterol >2.6-4.1 mmol/l; 100-160 mg/dl) and 579 were at HR for CHD (LDL cholesterol >1.8-4.1 mmol/l; 70-160 mg/dl). They received 20 mg/day and 40 mg/day of the drug, respectively.
 

After this stabilization period, the patients were randomly assigned to either double their atorvastatin dose or to receive additional ezetimibe 10 mg.

After 6 weeks of treatment, attainment of primary and secondary lipid targets, as set by the 2009 Canadian Cardiovascular Society (CCS) and the 2007 Joint European Prevention (JEP) guidelines, were measured.

Patients receiving atorvastatin plus ezetimibe were nearly five times more likely to achieve LDL cholesterol treatment targets (< 2 mmol/l; 77 mg/dl) than those receiving a double dose of atorvastatin in both the MHR and HR groups.Ezetimibe add-on treatment also significantly increased the likelihood of patients in both groups achieving dual lipid targets compared with doubling the atorvastatin dose.

In addition to LDL cholesterol targets, these duel targets included apolipoprotein (apo) B, total cholesterol, high-density lipoprotein (HDL) cholesterol, non-HLD cholesterol, triglycerides, apo B/apo A-I, and hs-CRP.

Importantly, the researchers say that both the addition of ezetimibe to atorvastatin and doubling the atorvastatin dose improves the proportion of patients achieving single and dual lipid and hs-CRP targets.With regard to safety, there were no significant between-group differences in either study.
 

The team concludes that "intensive treatment with either therapy resulted in reductions in the levels of hs-CRP, as well as LDL cholesterol, but this occurred to a greater extent in the ezetimibe add-on group."