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Ezetimibe, cardiovascular risk and atherogenic dyslipidaemia

By Manfredi Rizzo and Giovam Battista Rini

Abstract

Ezetimibe is a selective cholesterol absorption inhibitor with an excellent side-effect profile, able to reduce low-density lipoprotein (LDL) cholesterol by 15-25% from baseline in monotherapy and on top of statins and fibrates. Yet, it seems that ezetimibe produces quantitative rather than qualitative changes in LDL, with small net effects on atherogenic dyslipidaemia. This is supported by findings from the Ezetimibe and Simvastatin in Hypercholesterolemia Enhances Atherosclerosis Regression (ENHANCE) study on atherosclerosis progression, where the addition of ezetimibe to simvastatin in patients with heterozygous familial hypercholesterolaemia did not affect the mean change in carotid intima-media thickness, although a significant reduction in LDL cholesterol levels was observed. The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study has further shown that combination treatment with simvastatin significantly reduced LDL cholesterol levels in patients with aortic stenosis, but did not affect the primary end point of aortic valve and cardiovascular events, although a significant reduction in the risk of ischaemic events was reported. Formal cardiovascular outcome trials are underway and these will provide additional insights into the long-term effects of ezetimibe on clinical events as well as on atherogenic dyslipidaemia, beyond LDL cholesterol levels

Topics: Review Paper
Publisher: Termedia Publishing House
OAI identifier: oai:pubmedcentral.nih.gov:3258692
Provided by: PubMed Central

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Citations

  1. (2010). Cholesterol drug lowers LDL-C levels but again fails to show clinical benefit. JAMA
  2. (2007). Clinical importance and therapeutic modulation of small dense low-density lipoprotein particles. Expert Opin Biol Ther
  3. (2008). Combination therapy in cholesterol reduction: focus on ezetimibe and statins. Vasc Health Risk Manag
  4. (2006). Complementary therapy to target LDL cholesterol: the role of the ezetimibe/simvastatin combination. Vasc Health Risk Manag
  5. (2009). dense lowdensity lipoproteins are predictors of cardio- and cerebrovascular events in subjects with the metabolic syndrome. Clin Endocrinol
  6. (2007). Effect of ezetimibe on lipoprotein subfraction concentrations: the role of atorvastatin pretreatment. Arch Med Sci
  7. (2008). ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia.
  8. (2008). Rationale and design of IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial): comparison of ezetimibe/simvastatin versus simvastatin monotherapy on cardiovascular outcomes in patients with acute coronary syndromes. Am Heart J
  9. (2009). Sampalis JS. Co-administration of ezetimibe and a statin in management of dyslipidemias: a meta-analysis of clinical trials. Arch Med Sci
  10. (2009). Should we routinely measure low-density and high-density lipoprotein subclasses? Clin Lab
  11. (2010). Targeting dyslipidemia in the metabolic syndrome: an update. Curr Vasc Pharmacol
  12. (2009). The effects of ezetimibe on LDL-cholesterol: quantitative or qualitative changes? Atherosclerosis
  13. (2009). The predictive role of atherogenic dyslipidemia in subjects with non-coronary atherosclerosis. Clin Chim Acta
  14. (2005). The use of ezetimibe in achieving low density lipoprotein lowering goals in clinical practice: position statement of a United Kingdom consensus panel. Curr Med Res Opin

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