CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect  compared with statin monotherapy .
AIMS Statins are known to influence the status of adipokines , which play a key role in the pathophysiology of cardiometabolic diseases .
As the effect of ezetimibe as an add-on to statin therapy on the impact of statins on plasma adipokines levels is currently unclear , the aim of the present study was to investigate this through a meta- analysis of controlled trials .
Synergistic effect of simvastatin and ezetimibe on lipid and pro-inflammatory profiles in pre-diabetic subjects
Background Ezetimibe specifically blocks the absorption of dietary and biliary cholesterol and plant sterols . Synergism of ezetimibe-statin therapy on LDL-cholesterol has been demonstrated , but data concerning the pleiotropic effects of this combination are controversial . Objective This open-label trial evaluated whether the combination of simvastatin and ezetimibe also results in a synergistic effect that reduces the pro-inflammatory status of pre-diabetic subjects . Methods Fifty pre-diabetic subjects were r and omly assigned to one of 2 groups , one receiving ezetimibe ( 10 mg/day ) , the other , simvastatin ( 20 mg/d ) for 12 weeks , followed by an additional 12-week period of combined therapy . Blood sample s were collected at baseline , 12 and 24 weeks . RESULTS : Total cholesterol , LDL-cholesterol and apolipoprotein B levels decreased in all the periods analyzed ( p < 0.01 ) , but triglycerides declined significantly only after combined therapy . Both drugs induced reductions in C-reactive protein , reaching statistical significance after combining ezetimibe with the simvastatin therapy ( baseline 0.59 ± 0.14 , simvastatin monotherapy 0.48 ± 0.12 mg/dL and 0.35 ± 0.12 mg/dL , p < 0.023 ) . Such a reduction was independent of LDL-cholesterol change . However , mean levels of TNF-α and interleukin-6 and leukocyte count did not vary during the whole study . Conclusion Expected synergistic lowering effects of a simvastatin and ezetimibe  combination on LDL-cholesterol , apolipoprotein B and triglycerides levels were confirmed in subjects with early disturbances of glucose metabolism . We suggest an additive effect of this combination also on inflammatory status based on the reduction of C-reactive protein . Attenuation of pro-inflammatory conditions may be relevant in reducing cardiometabolic risk . Title/ID of trial registration Effect of simvastatin and ezetimibe on lipid and inflammation/NCT01103648
CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect  compared with statin monotherapy .
AIMS Statins are known to influence the status of adipokines , which play a key role in the pathophysiology of cardiometabolic diseases .
As the effect of ezetimibe as an add-on to statin therapy on the impact of statins on plasma adipokines levels is currently unclear , the aim of the present study was to investigate this through a meta- analysis of controlled trials .