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 .
Efficacy and safety of ezetimibe added to atorvastatin versus atorvastatin uptitration or switching to rosuvastatin in patients with primary hypercholesterolemia.
Hypercholesterolemic patients ( n = 1,547 ) at high atherosclerotic cardiovascular disease risk with low-density lipoprotein cholesterol ( LDL-C ) levels ≥100 and ≤160 mg/dl while treated with atorvastatin 10 mg/day entered a multicenter , r and omized , double-blind , active-controlled , clinical trial using two 6-week study periods . Period I compared the efficacy/safety of ( 1 ) adding ezetimibe 10 mg ( ezetimibe ) to stable atorvastatin 10 mg , ( 2 ) doubling atorvastatin to 20 mg , or ( 3 ) switching to rosuvastatin 10 mg . Subjects in the latter 2 groups who persisted with elevated LDL-C levels ( ≥100 and ≤160 mg/dl ) after period I , entered period II ; subjects on atorvastatin 20 mg had ezetimibe added to their atorvastatin 20 mg , or uptitrated their atorvastatin to 40 mg ; subjects on rosuvastatin 10 mg switched to atorvastatin 20 mg plus ezetimibe or uptitrated their rosuvastatin to 20 mg . Some subjects on atorvastatin 10 mg plus ezetimibe continued the same treatment into period II . At the end of period I , ezetimibe plus atorvastatin 10 mg reduced LDL-C significantly more than atorvastatin 20 mg or rosuvastatin 10 mg ( 22.2 % vs 9.5 % or 13.0 % , respectively , p < 0.001 ) . At the end of period II , ezetimibe plus atorvastatin 20 mg reduced LDL-C significantly more than atorvastatin 40 mg ( 17.4 % vs 6.9 % , p < 0.001 ) ; switching from rosuvastatin 10 mg to ezetimibe plus atorvastatin 20 mg reduced LDL-C significantly more than uptitrating to rosuvastatin 20 mg ( 17.1 % vs 7.5 % , p < 0.001 ) . Relative to comparative treatments , ezetimibe added to atorvastatin 10 mg ( period I ) or atorvastatin 20 mg ( period II ) produced significantly greater percent attainment of LDL-C targets < 100 or < 70 mg/dl , and significantly greater percent reductions in total cholesterol , non-high-density lipoprotein cholesterol , most lipid and lipoprotein ratios , and apolipoprotein B ( except ezetimibe plus atorvastatin 20 vs atorvastatin 40 mg ) . Reports of adverse experiences were generally similar among groups . In conclusion , treatment of hypercholesterolemic subjects at high cardiovascular risk with ezetimibe added to atorvastatin 10 or 20 mg produced significantly greater improvements in key lipid parameters and significantly greater attainment of LDL-C treatment targets than doubling atorvastatin or switching to ( or doubling ) rosuvastatin at the compared doses
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 .