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 10/40 mg versus atorvastatin 40 mg in high cardiovascular risk patients with primary hypercholesterolemia: a randomized, double-blind, active-controlled, multicenter study
Background A considerable number of patients with severely elevated LDL-C do not achieve recommended treatment targets , despite treatment with statins . Adults at high cardiovascular risk with hypercholesterolemia and LDL-C ≥ 2.59 and ≤ 4.14 mmol/L ( N = 250 ) , pretreated with atorvastatin 20 mg were r and omized to ezetimibe/simvastatin 10/40 mg or atorvastatin 40 mg for 6 weeks . The percent change in LDL-C and other lipids was assessed using a constrained longitudinal data analysis method with terms for treatment , time , time-by-treatment interaction , stratum , and time-by-stratum interaction . Percentage of subjects achieving LDL-C < 1.81 mmol/L , < 2.00 mmol/L , or < 2.59 mmol/L was assessed using a logistic regression model with terms for treatment and stratum . Tolerability was assessed . Results Switching to ezetimibe/simvastatin result ed in significantly greater changes in LDL-C ( -26.81 % vs.-11.81 % ) , total cholesterol ( -15.97 % vs.-7.73 % ) , non-HDL-C ( -22.50 % vs.-10.88 % ) , Apo B ( -17.23 % vs.-9.53 % ) , and Apo A-I ( 2.56 % vs.-2.69 % ) vs. doubling the atorvastatin dose ( all p ≤ 0.002 ) , but not HDL-C , triglycerides , or hs-CRP . Significantly more subjects achieved LDL-C < 1.81 mmol/L ( 29 % vs. 5 % ) , < 2.00 mmol/L ( 38 % vs. 9 % ) or < 2.59 mmol/L ( 69 % vs. 41 % ) after switching to ezetimibe/simvastatin vs. doubling the atorvastatin dose ( all p < 0.001 ) . The overall safety profile appeared generally comparable between treatment groups . Conclusions In high cardiovascular risk subjects with hypercholesterolemia already treated with atorvastatin 20 mg but not at LDL-C < 2.59 mmol/L , switching to combination ezetimibe/simvastatin 10/40 mg provided significantly greater LDL-C lowering and greater achievement of LDL-C targets compared with doubling the atorvastatin dose to 40 mg . Both treatments were generally well-tolerated . Trial registration Registered at clinical trials.gov :
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 .