Similar trends were observed for changes in total cholesterol .
Implication sGiven the available data , the addition of ezetimibe to ongoing simvastatin , atorvastatin , or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of CVD compared to doubling the initial statin dose
Purpose While statins are used as first-line treatments for high-risk patients with hypercholesterolemia , statin monotherapy is often insufficient to achieve target low-density lipoprotein cholesterol ( LDL-C ) levels .
Second-line treatment options include up-titration of statin dose , switching to a more potent statin , or combination therapy , e.g. , with ezetimibe .
The aim of this study was to evaluate the efficacy of adding ezetimibe to simvastatin , atorvastatin , or rosuvastatin monotherapy versus doubling the dosage or switching to a higher-potency statin in a population of patients with hypocholesterolemia at high risk of cardiovascular disease ( CVD ) and who had been previously treated with a statin .
Ezetimibe/simvastatin 10/20 mg versus simvastatin 40 mg in coronary heart disease patients.
BACKGROUND Reducing low-density lipoprotein cholesterol ( LDL-C ) is the primary goal of therapy in patients with hypercholesterolemia and coronary heart disease ( CHD ) . METHODS This double blind placebo-controlled study enrolled patients 18 to 75 years of age with primary hypercholesterolemia and established CHD who were taking a stable daily dose of simvastatin 20 mg . Patients were r and omized to ezetimibe/simvastatin 10/20 mg ( eze/simva ; n = 56 ) or simvastatin 40 mg ( simva ; n = 56 ) for 6 weeks . Percent change from baseline in LDL-C , total cholesterol , high-density lipoprotein cholesterol ( HDL-C ) , and triglycerides were assessed by use of the Student t test . The percent of patients achieving LDL-C less than 100 mg/dL ( < 2.6 mmol/L ) or less than 80 mg/dL ( < 2.0 mmol/L ) was analyzed via logistic regression with terms for treatment , baseline LDL-C , age , and gender . RESULTS Baseline characteristics were similar between groups . Treatment with eze/simva combination result ed in significantly greater reductions in LDL-C , total cholesterol , and triglycerides versus doubling the dose of simva to 40 mg ( all P < .01 ) . Significantly more patients achieved LDL-C less than 100 mg/dL ( < 2.6 mmol/L ) and less than 80 mg/dL ( < 2.0 mmol/L ) with ezetimibe/simvastatin versus doubling the dose of simva to 40 mg ( 73.2 % vs 25.0 % ; P < .001 ) for simvastatin .  Changes in HDL-C were similar between treatments . Both treatments were generally well tolerated . CONCLUSION In high-risk CHD patients with hypercholesterolemia , treatment with eze/simva combination result ed in significantly greater reductions in LDL-C , total cholesterol and triglycerides , as well as greater achievement of recommended LDL-C targets , compared with doubling the simvastatin dose to 40 mg over the 6-week period . ( CLINICAL TRIAL REGISTRATION NUMBER NCT00423579 )
Similar trends were observed for changes in total cholesterol .
Implication sGiven the available data , the addition of ezetimibe to ongoing simvastatin , atorvastatin , or rosuvastatin monotherapy offers greater reduction in LDL-C among patients at high risk of CVD compared to doubling the initial statin dose
Purpose While statins are used as first-line treatments for high-risk patients with hypercholesterolemia , statin monotherapy is often insufficient to achieve target low-density lipoprotein cholesterol ( LDL-C ) levels .
Second-line treatment options include up-titration of statin dose , switching to a more potent statin , or combination therapy , e.g. , with ezetimibe .
The aim of this study was to evaluate the efficacy of adding ezetimibe to simvastatin , atorvastatin , or rosuvastatin monotherapy versus doubling the dosage or switching to a higher-potency statin in a population of patients with hypocholesterolemia at high risk of cardiovascular disease ( CVD ) and who had been previously treated with a statin .