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 .
Incremental cholesterol reduction with ezetimibe/simvastatin, atorvastatin and rosuvastatin in UK General Practice (IN-PRACTICE): randomised controlled trial of achievement of Joint British Societies (JBS-2) cholesterol targets.
AIM The aim of this study was to compare ezetimibe/simvastatin combination therapy with intensified statin monotherapy as alternative treatment strategies to achieve the Joint British Societies (JBS)-2 and National Institute for Health and Clinical Excellence low-density-lipoprotein cholesterol ( LDL-C ) target of < 2 mmol/l for secondary prevention or JBS-2 LDL-C target of < 2 mmol/l for primary prevention in high-risk patients who have failed to reach target with simvastatin 40 mg . METHODS This is a prospect i ve , double-blind study conducted in 34 UK primary care centres ; 1748 patients with established cardiovascular disease ( CVD ) , diabetes or high risk of CVD who had been taking simvastatin 40 mg for > or = 6 weeks were screened and 786 ( 45 % ) with fasting LDL-C > or = 2.0 mmol/l ( and < 4.2 mmol/l ) at screening and after a further 6-week run-in period on simvastatin 40 mg were r and omised to ezetimibe/simvastatin 10/40 mg ( as a combination tablet ; n = 261 ) , atorvastatin 40 mg ( n = 263 ) or rosuvastatin 5 mg ( n = 73 ) or 10 mg ( n = 189 ) once daily for 6 weeks . Rosuvastatin dose was based on UK prescribing instructions . The primary outcome measure was the proportion of patients achieving LDL-C < 2 mmol/l at the end of the study . RESULTS The percentage of patients ( adjusted for baseline differences ) achieving LDL-C < 2 mmol/l was 69.4 % with ezetimibe/simvastatin 10/40 mg , compared with 33.5 % for atorvastatin 40 mg [ odds ratio 4.5 ( 95 % CI : 3.0 - 6.8 ) ; p < 0.001 ] and 14.3 % for rosuvastatin 5 or 10 mg [ odds ratio 13.6 ( 95 % CI : 8.6 - 21.6 ) ; p < 0.001 ] . Similar results were observed for achievement of total cholesterol < 4.0 mmol/l . All study treatments were well tolerated . CONCLUSION Approximately 45 % of patients screened had not achieved LDL-C < 2 mmol/l after > or = 12 weeks of treatment with simvastatin 40 mg . In this group , treatment with ezetimibe/simvastatin 10/40 mg achieved target LDL-C levels in a significantly higher proportion of patients during a 6-week period than switching to either atorvastatin 40 mg or rosuvastatin 5 - 10 mg
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 .