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 .
Effects of switching statins on achievement of lipid goals: Measuring Effective Reductions in Cholesterol Using Rosuvastatin Therapy (MERCURY I) study.
BACKGROUND In a multinational trial ( 4522IL/0081 ) , we assessed the effects of switching to low doses of rosuvastatin from commonly used doses of atorvastatin , simvastatin , and pravastatin on low-density lipoprotein cholesterol ( LDL-C ) goal achievement in high-risk patients . METHODS Hypercholesterolemic patients ( n = 3140 ) with coronary heart disease , atherosclerosis , or type 2 diabetes were r and omized to open-label rosuvastatin 10 mg , atorvastatin 10 or 20 mg , simvastatin 20 mg , or pravastatin 40 mg for 8 weeks . Patients either remained on these treatments for another 8 weeks or switched treatments from atorvastatin 10 mg , simvastatin 20 mg , and pravastatin 40 mg to rosuvastatin 10 mg or from atorvastatin 20 mg to rosuvastatin 10 or 20 mg . The primary efficacy measure was the proportion of patients reaching the Joint European Societies ' LDL-C goal ( < 116 mg/dL ) at week 16 . For measures of cholesterol goal achievement , treatment arms were compared using logistic-regression analysis . RESULTS Significant improvement in LDL-C goal achievement was found for patients who switched to rosuvastatin 10 mg , compared with patients who remained on atorvastatin 10 mg ( 86 % vs 80 % , P < .05 ) , simvastatin 20 mg ( 86 % vs 72 % , P < .0001 ) , and pravastatin 40 mg ( 88 % vs 66 % , P < .0001 ) , and between patients switched to rosuvastatin 20 mg and those who remained on atorvastatin 20 mg ( 90 % vs 84 % , P < .01 ) . Similar results were found for achievement of the European combined LDL-C and total cholesterol goals and National Cholesterol Education Program Adult Treatment Panel III LDL-C goals . All statins were well tolerated over 16 weeks . CONCLUSIONS We demonstrated that switching to a more efficacious statin is an effective strategy to improve lipid goal achievement in patients requiring lipid-lowering therapy
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 .