Efficacy, safety and tolerability of ongoing statin plus ezetimibe versus doubling the ongoing statin dose in hypercholesterolemic Taiwanese patients: An open-label, randomized clinical trial

被引:10
作者
Chih-Chieh Yu
Wen-Ter Lai
Kuang-Chung Shih
Tsung-Hsien Lin
Chieh-Hua Lu
Hung-Jen Lai
Mary E Hanson
Juey-Jen Hwang
机构
[1] National Taiwan University Hospital, Taipei
[2] Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung
[3] Tri-Service General Hospital, Taipei
[4] MSD Taiwan, Taipei
[5] Merck Sharp and Dohme Corp, Whitehouse Station, NJ
[6] Department of Internal Medicine, National Taiwan University, College of Medicine and Hospital, Taipei
关键词
Atorvastatin; Ezetimibe; Pravastatin; Simvastatin;
D O I
10.1186/1756-0500-5-251
中图分类号
学科分类号
摘要
Background: Reducing low-density lipoprotein cholesterol (LDL-C) is associated with reduced risk for major coronary events. Despite statin efficacy, a considerable proportion of statin-treated hypercholesterolemic patients fail to reach therapeutic LDL-C targets as defined by guidelines. This study compared the efficacy of ezetimibe added to ongoing statins with doubling the dose of ongoing statin in a population of Taiwanese patients with hypercholesterolemia. Methods. This was a randomized, open-label, parallel-group comparison study of ezetimibe 10 mg added to ongoing statin compared with doubling the dose of ongoing statin. Adult Taiwanese hypercholesterolemic patients not at optimal LDL-C levels with previous statin treatment were randomized (N = 83) to ongoing statin + ezetimibe (simvastatin, atorvastatin or pravastatin + ezetimibe at doses of 20/10, 10/10 or 20/10 mg) or doubling the dose of ongoing statin (simvastatin 40 mg, atorvastatin 20 mg or pravastatin 40 mg) for 8 weeks. Percent change in total cholesterol, LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglycerides, and specified safety parameters were assessed at 4 and 8 weeks. Results: At 8 weeks, patients treated with statin + ezetimibe experienced significantly greater reductions compared with doubling the statin dose in LDL-C (26.2% vs 17.9%, p = 0.0026) and total cholesterol (20.8% vs 12.2%, p = 0.0003). Percentage of patients achieving treatment goal was greater for statin + ezetimibe (58.6%) vs doubling statin (41.2%), but the difference was not statistically significant (p = 0.1675). The safety and tolerability profiles were similar between treatments. Conclusion: Ezetimibe added to ongoing statin therapy resulted in significantly greater lipid-lowering compared with doubling the dose of statin in Taiwanese patients with hypercholesterolemia. Studies to assess clinical outcome benefit are ongoing. Trial registration. Registered at ClinicalTrials.gov: NCT00652327. © 2012 Yu et al.; licensee BioMed Central Ltd.
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共 43 条
[1]  
Chen Z., Peto R., Collins R., MacMahon S., Lu J., Li W., Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations, BMJ, 303, pp. 276-282, (1991)
[2]  
Moran A., Gu D., Zhao D., Coxson P., Wang Y.C., Chen C.S., Liu J., Cheng J., Bibbins-Domingo K., Shen Y.M., Future cardiovascular disease in china: Markov model and risk factor scenario projections from the coronary heart disease policy model-china, Circ Cardiovasc Qual Outcomes, 3, pp. 243-252, (2010)
[3]  
Gaziano J.M., Hebert P.R., Hennekens C.H., Cholesterol reduction: Weighing the benefits and risks, Annals of Internal Medicine, 124, 10, pp. 914-918, (1996)
[4]  
Sacks F.M., Pfeffer M.A., Moye L.A., Rouleau J.L., Rutherford J.D., Cole T.G., Brown L., Warnica J.W., Arnold J.M.O., Wun C.-C., Davis B.R., Braunwald E., The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels, New England Journal of Medicine, 335, 14, pp. 1001-1009, (1996)
[5]  
Shepherd J., Cobbe S.M., Ford I., Isles C.G., Lorimer A.R., MacFarlane P.W., McKillop J.H., Packard C.J., Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group, N Engl J Med, 333, pp. 1301-1307, (1995)
[6]  
Downs J.R., Clearfield M., Weis S., Whitney E., Shapiro D.R., Beere P.A., Langendorfer A., Stein E.A., Kruyer W., Gotto Jr. A.M., Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: Results of AFCAPS/TexCAPS, Journal of the American Medical Association, 279, 20, pp. 1615-1622, (1998)
[7]  
Haffner S.M., The Scandinavian Simvastatin Survival Study (4S) subgroup analysis of diabetic subjects: Implications for the prevention of coronary heart disease, Diabetes Care, 20, pp. 469-471, (1997)
[8]  
Cannon C.P., Braunwald E., McCabe C.H., Rader D.J., Rouleau J.L., Belder R., Joyal S.V., Hill K.A., Pfeffer M.A., Skene A.M., Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes, New England Journal of Medicine, 350, 15, pp. 1495-1504, (2004)
[9]  
Rossouw J.E., Lipid-lowering interventions in angiographic trials, Am J Cardiol, 76, (1995)
[10]  
Law M.R., Wald N.J., Thompson S.G., By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease?, British Medical Journal, 308, 6925, pp. 367-372, (1994)