Clinical usefulness of additional treatment with ezetimibe in patients with coronary artery disease on statin therapy: From the viewpoint of cholesterol metabolism

Abstract

Background: Ezetimibe-plus-statin therapy has been reported to provide greater reduction in low-density lipoprotein cholesterol (LDL-C) level than statin monotherapy. The aim of the present study was to evaluate the relationship between LDL-C lowering effect and baseline cholesterol absorption and synthesis markers in patients with coronary artery disease (CAD). Methods and Results: A total of 171 patients with CAD whose LDL-C level was ≥100 mg/dl after treatment with atorvastatin (10 mg/day) or rosuvastatin (2.5 mg/day) for 4 weeks were assigned to additionally receive ezetimibe (10 mg/day) plus a statin or a double dose of statin for 12 weeks. The decreases in LDL-C (-30.0±15.6 mg/dl vs. -19.2±14.2 mg/dl) and the ratio of campesterol, an absorption marker, to total cholesterol levels (-1.35±0.90μ g/mg vs. 0.33±0.74 μg/mg) were greater in the ezetimibe-plus-statin group (P<0.05, respectively). The decrease in LDL-C level in the ezetimibe-plus-statin group was greatest in patients with baseline levels of higher absorption and lower synthesis markers and smallest in patients with baseline levels of lower absorption and higher synthesis markers (-34.3±15.6 mg/dl vs. -21.5±16.7 mg/dl, P<0.05). The decrease in LDL-C did not differ, irrespective of baseline levels of cholesterol absorption and synthesis markers, in the double-dose statin group, and was similar to that in patients with lower absorption and higher synthesis markers in the ezetimibe-plus-statin group. Conclusions: Ezetimibe-plus-statin therapy may be useful for lowering LDL-C level, irrespective of baseline levels of cholesterol absorption and synthesis markers. © All rights are reserved to the Japanese Circulation Society.