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Jun JE, Jeong IK, Ahn KJ, Chung HY, Hwang YC. Combination of low- or moderate-intensity statin and ezetimibe vs. high-intensity statin monotherapy on primary prevention of cardiovascular disease and all-cause death: a propensity-matched nationwide cohort study. Eur J Prev Cardiol 2024; 31:1205-1213. [PMID: 38408362 DOI: 10.1093/eurjpc/zwae081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Abstract
AIMS This study aims to compare the preventive effect of low- or moderate-statin with ezetimibe combination therapy and high-intensity statin monotherapy on cardiovascular disease (CVD) and all-cause death in a real-world setting. METHODS AND RESULTS Using the Korean National Health Insurance Service datasets, two cohorts comparing high-intensity statin monotherapy with low- or moderate-intensity statin and ezetimibe combination were constructed by 1:1 propensity score matching procedure. Primary outcome was a composite of myocardial infarction (MI), stroke, and all-cause death. Secondary outcome was an individual event. The study population was followed from baseline until the date of events, or the last health check-ups, whichever came first. Compared to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination significantly reduced the risk of composite outcome [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.77-0.92, P < 0.001] as well as individual MI (HR 0.81, 95% CI 0.71-0.94, P = 0.005) and stroke (HR 0.78, 95% CI 0.65-0.93, P = 0.005), but not all-cause death. Low-intensity statin with ezetimibe also significantly reduced the risk of the composite outcomes (HR 0.80, 95% CI 0.66-0.97, P = 0.024) compared to high-intensity statin monotherapy, but the risk of individual outcome did not differ between two groups. Statin and ezetimibe combination demonstrated consistent effect across various subgroups. CONCLUSION Among people without pre-existing CVD, moderate-intensity statin with ezetimibe combination was superior to high-intensity statin monotherapy in preventing composite outcomes as well as each of MI and stroke. In contrast, low-intensity statin with ezetimibe combination reduced the risk of composite but not individual outcomes.
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Affiliation(s)
- Ji Eun Jun
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - In-Kyung Jeong
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - Kyu Jeong Ahn
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - Ho Yeon Chung
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
| | - You-Cheol Hwang
- Division of Endocrinology and Metabolism, Department of Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, #892 Dongnam-ro, Gangdong-gu, Seoul 05278, Republic of Korea
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Park SY, Jun JE, Jeong IK, Ahn KJ, Chung HY, Hwang YC. Comparison of the Efficacy of Ezetimibe Combination Therapy and High-Intensity Statin Monotherapy in Type 2 Diabetes. J Clin Endocrinol Metab 2024; 109:1883-1890. [PMID: 38175670 DOI: 10.1210/clinem/dgad714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Indexed: 01/05/2024]
Abstract
CONTEXT Low-density lipoprotein cholesterol (LDL-C)-lowering therapy is considerably important in preventing cardiovascular disease (CVD) among patients with diabetes. Studies comparing CVD, stroke, and mortality outcomes of low- or moderate-intensity statins with ezetimibe combination therapy and high-intensity statin monotherapy in patients with diabetes remain lacking. OBJECTIVE This study compared the primary prevention effect of myocardial infarction (MI), stroke, and all-cause death between combination therapy of low- or moderate-intensity statins and ezetimibe and high-intensity statin monotherapy in patients with diabetes using the Korean National Health Insurance claims database. METHODS Patients aged ≥20 years with type 2 diabetes and dyslipidemia were enrolled. The combination therapy of low- or moderate-intensity statin and ezetimibe was compared with high-intensity statin monotherapy after a propensity score-matched analysis. The incidence of composite outcomes consisting of MI, stroke, and all-cause death and each component were analyzed. RESULTS In moderate-intensity statin therapy with ezetimibe combination therapy, LDL-C (74 ± 37.9 mg/dL vs 80.8 ± 38.8 mg/dL, P < .001) and the incidence of composite outcomes were lower (hazard ratio 0.85, 95% CI 0.74-0.98) than those in high-intensity statin monotherapy. Meanwhile, no significant difference was observed in the LDL-C levels and composite outcomes between low-intensity statins with ezetimibe combination therapy and high-intensity statin monotherapy. CONCLUSION Adding ezetimibe to a moderate-intensity statin in patients with type 2 diabetes has a greater LDL-C-lowering effect and greater primary prevention of composite outcomes than that of high-intensity statin monotherapy.
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Affiliation(s)
- So Young Park
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul 02447, Republic of Korea
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
| | - Ji Eun Jun
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - In-Kyung Jeong
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Kyu Jeung Ahn
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - Ho Yeon Chung
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
| | - You-Cheol Hwang
- Department of Endocrinology & Metabolism, Kyung Hee University School of Medicine, Seoul 02453, Republic of Korea
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Leiherer A, Muendlein A, Saely CH, Geiger K, Brandtner EM, Heinzle C, Gaenger S, Mink S, Laaksonen R, Fraunberger P, Drexel H. Coronary Event Risk Test (CERT) as a Risk Predictor for the 10-Year Clinical Outcome of Patients with Peripheral Artery Disease. J Clin Med 2023; 12:6151. [PMID: 37834795 PMCID: PMC10573503 DOI: 10.3390/jcm12196151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
(1) Background: Ceramides are a new kind of lipid biomarker and have already been demonstrated to be valuable risk predictors in coronary patients. Patients with peripheral artery disease (PAD) are a population with a worse prognosis and higher mortality risk compared to coronary artery disease (CAD) patients. However, the value of ceramides for risk prediction in PAD patients is still vague, as addressed in the present study. (2)Methods: This observational study included 379 PAD patients. The primary endpoint was all-cause mortality at 10 years of follow-up. A set of ceramides was measured by LC-MS/MS and combined according to the Coronary Event Risk Test (CERT) score, which categorizes patients into one of four risk groups (low risk, moderate risk, high risk, very high risk). (3) Results: Kaplan-Meier survival curves revealed that the overall survival of patients decreased with the increasing risk predicted by the four CERT categories, advancing from low risk to very high risk. Cox regression analysis demonstrated that each one-category increase resulted in a 35% rise in overall mortality risk (HR = 1.35 [1.16-1.58]). Multivariable adjustment, including, among others, age, LDL-cholesterol, type 2 diabetes, and statin treatment before the baseline, did not abrogate this significant association (HR = 1.22 [1.04-1.43]). Moreover, we found that the beneficial effect of statin treatment is significantly stronger in patients with a higher risk, according to CERT. (4) Conclusions: We conclude that the ceramide-based risk score CERT is a strong predictor of the 10-year mortality risk in patients with PAD.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
| | - Christoph H. Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
| | - Kathrin Geiger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Eva-Maria Brandtner
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Stella Gaenger
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
| | - Sylvia Mink
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, FI-33014 Tampere, Finland;
- Zora Biosciences, FI-02150 Espoo, Finland
| | - Peter Fraunberger
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Medical Central Laboratories, A-6800 Feldkirch, Austria
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Academic Teaching Hospital Feldkirch, Carinagasse 47, A-6800 Feldkirch, Austria; (A.M.); (K.G.); (E.-M.B.); (S.G.); (H.D.)
- Private University of the Principality of Liechtenstein, FL-9495 Triesen, Liechtenstein; (S.M.); (P.F.)
- Vorarlberger Landeskrankenhausbetriebsgesellschaft, Academic Teaching Hospital Feldkirch, A-6800 Feldkirch, Austria
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
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Nakano Y, Yamamoto M, Matoba T, Katsuki S, Nakashiro S, Takase S, Akiyama Y, Nagata T, Mukai Y, Inoue S, Oi K, Higo T, Takemoto M, Suematsu N, Eshima K, Miyata K, Usui M, Sadamatsu K, Kadokami T, Hironaga K, Ichi I, Todaka K, Kishimoto J, Tsutsui H. Association between Serum Oxysterols and Coronary Plaque Regression during Lipid-Lowering Therapy with Statin and Ezetimibe: Insights from the CuVIC Trial. J Atheroscler Thromb 2023; 30:907-918. [PMID: 36450458 PMCID: PMC10406650 DOI: 10.5551/jat.63507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/23/2022] [Indexed: 08/04/2023] Open
Abstract
AIM Several clinical trials using intravascular ultrasound (IVUS) evaluation have demonstrated that intensive lipid-lowering therapy by statin or a combination therapy with statin and ezetimibe results in significant regression of coronary plaque volume. However, it remains unclear whether adding ezetimibe to statin therapy affects coronary plaque composition and the molecular mechanisms of plaque regression. We conducted this prospective IVUS analysis in a subgroup from the CuVIC trial. METHODS The CuVIC trial was a prospective randomized, open, blinded-endpoint trial conducted among 11 cardiovascular centers, where 260 patients with coronary artery disease who received coronary stenting were randomly allocated into either the statin group (S) or the combined statin and ezetimibe group (S+E). We enrolled 79 patients (S group, 39 patients; S+E group, 40 patients) in this substudy, for whom serial IVUS images of nonculprit lesion were available at both baseline and after 6-8 months of follow-up. RESULTS After the treatment period, the S+E group had significantly lower level of low-density lipoprotein cholesterol (LDL-C; 80.9±3.7 vs. 67.7±3.8 mg/dL, p=0.0143). Campesterol, a marker of cholesterol absorption, and oxysterols (β-epoxycholesterol, 4β-hydroxycholesterol, and 27-hydroxycholesterol) were also lower in the S+E group. IVUS analyses revealed greater plaque regression in the S+E group than in the S group (-6.14% vs. -1.18% for each group, p=0.042). It was noteworthy that the lowering of campesterol and 27-hydroxycholesterol, but not LDL-C, had a significant positive correlation with plaque regression. CONCLUSIONS Compared with statin monotherapy, ezetimibe in combination with statin achieved significantly lower LDL-C, campesterol, and 27-hydroxycholesterol, which resulted in greater coronary plaque regression.
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Affiliation(s)
- Yasuhiro Nakano
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Mitsutaka Yamamoto
- Department of Cardiovascular Medicine, Harasanshin Hospital, Fukuoka, Japan
| | - Tetsuya Matoba
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shunsuke Katsuki
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Soichi Nakashiro
- Department of Cardiovascular Medicine, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Susumu Takase
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yusuke Akiyama
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takuya Nagata
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Yasushi Mukai
- Department of Cardiovascular Medicine, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Shujiro Inoue
- Department of Cardiovascular Medicine, Aso Iizuka Hospital, Fukuoka, Japan
| | - Keiji Oi
- Department of Cardiovascular Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Taiki Higo
- Department of Cardiovascular Medicine, National Hospital Organization Kyushu Medical Centre, Fukuoka, Japan
| | - Masao Takemoto
- Cardiovascular Center, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Nobuhiro Suematsu
- Department of Cardiovascular Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Kenichi Eshima
- Department of Cardiovascular Medicine, Saga-ken Medical Centre Koseikan, Saga, Japan
| | - Kenji Miyata
- Department of Cardiovascular Medicine, Japan Community Health Care Organization, Kyushu Hospital, Fukuoka, Japan
| | - Makoto Usui
- Department of Cardiovascular Medicine, Hamanomachi Hospital, Fukuoka, Japan
| | - Kenji Sadamatsu
- Department of Cardiovascular Medicine, Omuta City Hospital, Fukuoka, Japan
| | - Toshiaki Kadokami
- Department of Cardiovascular Medicine, Saiseikai Futsukaichi Hospital, Fukuoka, Japan
| | - Kiyoshi Hironaga
- Department of Cardiovascular Medicine, Fukuoka City Hospital, Fukuoka, Japan
| | - Ikuyo Ichi
- Graduate School of Humanities and Science, Ochanomizu University, Tokyo, Japan
| | - Koji Todaka
- Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research of Kyushu University Hospital, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
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Barkas F, Bathrellou E, Nomikos T, Panagiotakos D, Liberopoulos E, Kontogianni MD. Plant Sterols and Plant Stanols in Cholesterol Management and Cardiovascular Prevention. Nutrients 2023; 15:2845. [PMID: 37447172 DOI: 10.3390/nu15132845] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the major mortality cause in developed countries with hypercholesterolaemia being one of the primary modifiable causes. Lifestyle intervention constitutes the first step in cholesterol management and includes dietary modifications along with the use of functional foods and supplements. Functional foods enriched with plant sterols/stanols have become the most widely used nonprescription cholesterol-lowering approach, despite the lack of randomized trials investigating their long-term safety and cardiovascular efficacy. The cholesterol-lowering effect of plant-sterol supplementation is well-established and a potential beneficial impact on other lipoproteins and glucose homeostasis has been described. Nevertheless, experimental and human observational studies investigating the association of phytosterol supplementation or circulating plant sterols with various markers of atherosclerosis and ASCVD events have demonstrated controversial results. Compelling evidence from recent genetic studies have also linked elevated plasma concentrations of circulating plant sterols with ASCVD presence, thus raising concerns about the safety of phytosterol supplementation. Thus, the aim of this review is to provide up-to-date data on the effect of plant sterols/stanols on lipid-modification and cardiovascular outcomes, as well as to discuss any safety issues and practical concerns.
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Affiliation(s)
- Fotios Barkas
- Department of Hygiene & Epidemiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Tzortzis Nomikos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
| | - Evangelos Liberopoulos
- 1st Propaedeutic Department of Medicine, General Hospital of Atherns 'Laiko', School of Medicine, National and Kapodistrιan University of Athens, 11527 Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University, 17676 Kallithea, Greece
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Kim BK, Hong SJ, Lee YJ, Hong SJ, Yun KH, Hong BK, Heo JH, Rha SW, Cho YH, Lee SJ, Ahn CM, Kim JS, Ko YG, Choi D, Jang Y, Hong MK. Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial. Lancet 2022; 400:380-390. [PMID: 35863366 DOI: 10.1016/s0140-6736(22)00916-3] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Drug combinations rather than increasing doses of one drug can achieve greater efficacy and lower risks. Thus, as an alternative to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination therapy can lower LDL cholesterol concentrations effectively while reducing adverse effects. However, evidence from randomised trials to compare long-term clinical outcomes is needed. METHODS In this randomised, open-label, non-inferiority trial, patients with atherosclerotic cardiovascular disease (ASCVD) at 26 clinical centres in South Korea were randomly assigned (1:1) to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg) or high-intensity statin monotherapy (rosuvastatin 20 mg). The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke, in the intention-to-treat population with a non-inferiority margin of 2·0%. This trial is registered with ClinicalTrials.gov, NCT03044665 and is complete. FINDINGS Between Feb 14, 2017, and Dec 18, 2018, 3780 patients were enrolled: 1894 patients to the combination therapy group and 1886 to the high-intensity statin monotherapy group. The primary endpoint occurred in 172 patients (9·1%) in the combination therapy group and 186 patients (9·9%) in the high-intensity statin monotherapy group (absolute difference -0·78%; 90% CI -2·39 to 0·83). LDL cholesterol concentrations of less than 70 mg/dL at 1, 2, and 3 years were observed in 73%, 75%, and 72% of patients in the combination therapy group, and 55%, 60%, and 58% of patients in the high-intensity statin monotherapy group (all p<0·0001). Discontinuation or dose reduction of the study drug by intolerance was observed in 88 patients (4·8%) and 150 patients (8·2%), respectively (p<0·0001). INTERPRETATION Among patients with ASCVD, moderate-intensity statin with ezetimibe combination therapy was non-inferior to high-intensity statin monotherapy for the 3-year composite outcomes with a higher proportion of patients with LDL cholesterol concentrations of less than 70 mg/dL and lower intolerance-related drug discontinuation or dose reduction. FUNDING Hanmi Pharmaceutical.
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Affiliation(s)
- Byeong-Keuk Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Joon Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Soon Jun Hong
- Korea University College of Medicine, Seoul, South Korea
| | | | | | - Jung Ho Heo
- Kosin University College of Medicine, Busan, South Korea
| | | | | | - Seung-Jun Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, South Korea.
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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7
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Leiherer A, Mündlein A, Laaksonen R, Lääperi M, Jylhä A, Fraunberger P, Drexel H. Comparison of recent ceramide-based coronary risk prediction scores in cardiovascular disease patients. Eur J Prev Cardiol 2021; 29:947-956. [PMID: 34417607 DOI: 10.1093/eurjpc/zwab112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/27/2021] [Accepted: 06/10/2021] [Indexed: 12/27/2022]
Abstract
AIM Cholesterol-based risk prediction is often insufficient in cardiovascular disease (CVD) patients. Ceramides are a new kind of biomarkers for CVD. The Coronary Event Risk Test (CERT) is a validated cardiovascular risk predictor that uses only circulating ceramide levels, determined by coupled liquid chromatography-mass spectrometry, to allocate patients into one of four risk categories. This test has recently been modified (CERT2) by additionally including phosphatidylcholine levels. METHODS AND RESULTS In this observational cohort study, we have recruited 999 Austrian patients with CVD and followed them for up to 13 years. We found that CERT and CERT2 both predicted cardiovascular events, cardiovascular mortality, and overall mortality. CERT2 had the higher performance compared to CERT and also to the recent cardiovascular risk score of the ESC/EAS guidelines (Systematic COronary Risk Evaluation (SCORE)) for low-risk European countries. Combining CERT2 with the ESC/EAS-SCORE, predictive capacity was further increased leading to a hazard ratio of 3.58 (2.02-6.36; P < 0.001) for cardiovascular events, 11.60 (2.72-49.56; P = 0.001) for cardiovascular mortality, and 9.86 (4.23-22.99; P < 0.001) for overall mortality when patients with very high risk (category 4) were compared to those with low risk (category 1). The use of the combined score instead of the ESC/EAS-SCORE significantly improved the predictive power according to the integrated discrimination improvement index (P = 0.004). CONCLUSION We conclude that CERT and CERT2 are powerful predictors of cardiovascular events, cardiovascular mortality, and overall mortality in CVD patients. Including phosphatidylcholine to a ceramide-based score increases the predictive performance and is best in combination with classical risk factors as used in the ESC/EAS-SCORE.
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Affiliation(s)
- Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Medical Central Laboratories, Carinagasse 41, A-6807, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Axel Mündlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Reijo Laaksonen
- Finnish Cardiovascular Research Center, University of Tampere, Arvo Ylpön katu 34, 33520 Tampere, Finland.,Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Mitja Lääperi
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Antti Jylhä
- Zora Biosciences Oy, Tietotie 2C, 02150 Espoo, Finland
| | - Peter Fraunberger
- Medical Central Laboratories, Carinagasse 41, A-6807, Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Carinagasse 47, A-6800 Feldkirch, Austria.,Private University of the Principality of Liechtenstein, Dorfstrasse 24 FL-9495 Triesen, Liechtenstein.,Department of Internal Medicine, Academic Teaching Hospital Bregenz, Carl-Pedenz-Str. 2, A-6900 Bregenz, Austria.,Drexel University College of Medicine, 2900 W Qeen Ln, PA 19129 Philadelphia, PA, USA
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8
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Pontremoli R, Bellizzi V, Bianchi S, Bigazzi R, Cernaro V, Del Vecchio L, De Nicola L, Leoncini G, Mallamaci F, Zoccali C, Buemi M. Management of dyslipidaemia in patients with chronic kidney disease: a position paper endorsed by the Italian Society of Nephrology. J Nephrol 2020; 33:417-430. [PMID: 32065354 PMCID: PMC7220980 DOI: 10.1007/s40620-020-00707-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/24/2020] [Indexed: 12/19/2022]
Abstract
Chronic kidney disease (CKD) represents a major public health issue worldwide and entails a high burden of cardiovascular events and mortality. Dyslipidaemia is common in patients with CKD and it is characterized by a highly atherogenic profile with relatively low levels of HDL-cholesterol and high levels of triglyceride and oxidized LDL-cholesterol. Overall, current literature indicates that lowering LDL-cholesterol is beneficial for preventing major atherosclerotic events in patients with CKD and in kidney transplant recipients while the evidence is less clear in patients on dialysis. Lipid lowering treatment is recommended in all patients with stage 3 CKD or worse, independently of baseline LDL-cholesterol levels. Statin and ezetimibe are the cornerstones in the management of dyslipidaemia in patients with CKD, however alternative and emerging lipid-lowering therapies may acquire a central role in near future. This position paper endorsed by the Italian Society of Nephrology aims at providing useful information on the topic of dyslipidaemia in CKD and at assisting decision making in the management of these patients.
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Affiliation(s)
- Roberto Pontremoli
- Università degli Studi and I.R.C.C.S. Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132, Genoa, Italy.
| | - Vincenzo Bellizzi
- Division of Nephrology, Dialysis and Transplantation, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Via San Leonardo, 84131, Salerno, Italy
| | - Stefano Bianchi
- Nephrology and Dialysis Complex Operative Unit, Department of Internal Medicine, ASL Toscana Nordovest, Livorno, Italy
| | - Roberto Bigazzi
- Nephrology and Dialysis Complex Operative Unit, Department of Internal Medicine, ASL Toscana Nordovest, Livorno, Italy
| | - Valeria Cernaro
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
| | - Lucia Del Vecchio
- Department of Nephrology and Dialysis, A. Manzoni Hospital, ASST Lecco, Lecco, Italy
| | - Luca De Nicola
- Nephrology Division, Department of Advanced Medical and Surgical Sciences, University of Campania "L. Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Giovanna Leoncini
- Università degli Studi and I.R.C.C.S. Ospedale Policlinico San Martino, Viale Benedetto XV 6, 16132, Genoa, Italy
| | - Francesca Mallamaci
- Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy.,CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Nefrologia-Ospedali Riuniti, 89100, Reggio Calabria, Italy
| | - Carmine Zoccali
- Nephrology, Dialysis and Transplantation Unit, Ospedali Riuniti, Reggio Calabria, Italy
| | - Michele Buemi
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98125, Messina, Italy
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9
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Shaposhnik II, Genkel VV. [Pleiotropic effects of ezetimibe]. KARDIOLOGIIA 2019; 59:12-17. [PMID: 31995721 DOI: 10.18087/cardio.n875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/13/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
The article discusses in detail the question of the additional positive effects of ezetimibe in addition to direct hypolipidemic action. The data of experimental and clinical studies in which the effect of ezetimibe on carbohydrate metabolism, inflammation, endothelial dysfunction, and liver is studied. The article also discusses the results of clinical studies that examined the effect of ezetimibe on atherosclerotic plaque.
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Affiliation(s)
- I I Shaposhnik
- Federal State Budgetary Educational Institution of Higher Education "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation
| | - V V Genkel
- Federal State Budgetary Educational Institution of Higher Education "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation
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10
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Abstract
PURPOSE OF REVIEW Recent studies and dyslipidemia treatment guidelines indicate that combination lipid-lowering therapy is frequently needed and its use has increased in recent years. Ezetimibe and simvastatin as a fixed dose is an efficacious treatment choice based on positive results of the recent IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT). In this review, we discuss recent controversies surrounding ezetimibe and provide clinical perspective on the results of the IMPROVE-IT study. RECENT FINDINGS IMPROVE-IT is the first trial that demonstrates a significant clinical benefit of a nonstatin hypolipidemic agent (ezetimibe) used in combination with statin (simvastatin) therapy in patients who have experienced an acute coronary syndrome. For almost a decade, the use of ezetimibe was limited by a relative lack of definitive evidence. However, the most recent Plaque Regression With Cholesterol Absorption Inhibitor or Synthesis Inhibitor Evaluated by Intravascular Ultrasound study showed greater coronary plaque regression by statin/ezetimibe combination compared with statin monotherapy. The results of the IMPROVE-IT trial are fostering new debate about the value of adjunctive low-density lipoprotein cholesterol lowering over and above a statin. SUMMARY Ezetimibe/simvastatin combination, either as a single pill or as the combined use of the individual compounds, represents a well-tolerated and efficacious choice for dyslipidemia treatment in high-risk subjects, including patients with diabetes. Limited additional risk for adverse events compared with simvastatin monotherapy is observed, and an individualized, patient-centered approach to therapy is recommended.
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Affiliation(s)
- Maciej Banach
- aDepartment of Hypertension, Chair of Nephrology and Hypertension, Medical University of Lodz, Poland bBiomedical Department of Internal Medicine and Medical Specialties, University of Palermo cEuro-Mediterranean Institute of Science and Technology, Palermo, Italy dCGH Medical Centre, Sterling, Illinois; University of Illinois, School of Medicine, Peoria, Illinois eJohns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Role of dual lipid-lowering therapy in coronary atherosclerosis regression: Evidence from recent studies. Atherosclerosis 2018; 269:219-228. [PMID: 29407597 DOI: 10.1016/j.atherosclerosis.2018.01.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/21/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
Abstract
Despite recent therapeutic advances, there is an unmet need in cardiovascular disease prevention. Clinical trials and meta-analyses have established that LDL-C lowering, particularly by statin therapy, reduces the progression of coronary atherosclerosis and the risk of coronary events. Insufficient LDL-C reduction and high residual risk in a significant proportion of statin-treated patients signify that additional therapies are required to deliver more effective coronary care. Pharmacological inhibition of cholesterol absorption (with ezetimibe) and PCSK9 activity (with evolocumab or alirocumab) provides potentially useful approaches for the therapeutic modulation of LDL-C metabolism in statin-treated patients. In recent trials, combination strategies involving a statin and non-statin agent (ezetimibe or evolocumab) have been shown to promote coronary atherosclerosis regression and improve cardiovascular outcomes in patients with moderate-to-high cardiovascular risk. This review summarizes recent evidence on the effects of dual lipid-lowering therapy on coronary atherosclerosis.
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12
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Dolezelova E, Stein E, Derosa G, Maffioli P, Nachtigal P, Sahebkar A. Effect of ezetimibe on plasma adipokines: a systematic review and meta-analysis. Br J Clin Pharmacol 2017; 83:1380-1396. [PMID: 28166606 DOI: 10.1111/bcp.13250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/22/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022] Open
Abstract
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. METHODS A systematic review was performed, followed by a bibliographic search in PubMed, Medline, SCOPUS, Web of Science and Google Scholar databases. Quantitative data synthesis was performed using a fixed- or random-effects model (based on the level of interstudy heterogeneity) and the generic inverse variance weighting method. Effect sizes were expressed as standardized mean difference (SMD) and 95% confidence interval (CI). RESULTS Meta-analysis of 23 controlled trials did not suggest any significant effect of adding ezetimibe on top of statin therapy on plasma concentrations of adiponectin (SMD 0.34, 95% CI -0.28, 0.96; P = 0.288), leptin (SMD -0.75, 95% CI: -2.35, 0.85; P = 0.360), plasminogen activator inhibitor 1 (SMD -1.06, 95% CI: -2.81, 0.69; P = 0.236) and interleukin 6 (SMD 0.30, 95% CI: -0.08, 0.67; P = 0.124). However, significantly greater reductions in plasma concentrations of tumour necrosis factor α (TNF-α) (SMD -0.48, 95% CI -0.87, -0.08; P = 0.018) were achieved with ezetimibe/statin combination therapy. CONCLUSIONS The results suggested that ezetimibe add-on to statin therapy is associated with an enhanced TNF-α-lowering effect compared with statin monotherapy. Owing to the emerging role of TNF-α in the pathogenesis of metabolic disorders, further investigations are required to unveil the translational relevance of this TNF-α-lowering effect.
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Affiliation(s)
- Eva Dolezelova
- Faculty of Pharmacy in Hradec Kralove, Department of Biological and Medical Sciences, Charles University, Hradec Kralove, Czech Republic
| | - Evan Stein
- Metabolic and Atherosclerosis Research Center, Cincinnati, OH, USA
| | - Giuseppe Derosa
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research, University of Pavia, Pavia, Italy.,Molecular Medicine Laboratory, University of Pavia, Pavia, Italy
| | - Pamela Maffioli
- Centre of Diabetes and Metabolic Diseases, Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Petr Nachtigal
- Faculty of Pharmacy in Hradec Kralove, Department of Biological and Medical Sciences, Charles University, Hradec Kralove, Czech Republic
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,School of Medicine, University of Western Australia, Perth, WA, Australia
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13
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Kirichenko TV, Sobenin IA, Nikolic D, Rizzo M, Orekhov AN. Anti-cytokine therapy for prevention of atherosclerosis. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2016; 23:1198-1210. [PMID: 26781385 DOI: 10.1016/j.phymed.2015.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Currently a chronic inflammation is considered to be the one of the most important reasons of the atherosclerosis progression. A huge amount of researches over the past few decades are devoted to study the various mechanisms of inflammation in the development of atherosclerotic lesions. PURPOSE To review current capabilities of anti-inflammatory therapy for the prevention and treatment of atherosclerosis and its clinical manifestations. METHODS Appropriate articles on inflammatory cytokines in atherosclerosis and anti-inflammatory prevention of atherosclerosis were searched in PubMed Database from their respective inceptions until October 2015. SECTIONS "The role of inflammatory cytokines in the development of atherosclerotic lesions" describes available data on the possible inflammatory mechanisms of the atherogenesis with a special attention to the role of cytokines. "Modern experience of anti-inflammatory therapy for the treatment of atherosclerosis" describes modern anti-inflammatory preparations with anti-atherosclerotic effect including natural preparations. In "the development of anti-inflammatory herbal preparation for atherosclerosis prevention" an algorithm is demonstrated that includes screening of anti-cytokine activity of different natural products, the development of the most effective combination and estimation of its effect in cell culture model, in animal model of the acute aseptic inflammation and in a pilot clinical trial. A natural preparation "Inflaminat" based on black elder berries (Sambucus nigra L.), violet tricolor herb (Viola tricolor L.) and calendula flowers (Calendula officinalis L.) possessing anti-cytokine activity was developed using the designed algorithm. The results of the following 2-year double blind placebo-controlled clinical study show that "Inflaminat" reduces carotid IMT progression, i.e. has anti-atherosclerotic effect. CONCLUSION Anti-cytokine therapy may be a promising direction in moderation of atherogenesis, especially when it begins on the early stages of subclinical atherosclerosis. The use of herbal preparations with anti-cytokine mechanism of action is the most perspective for timely prevention of atherosclerosis, as they have no significant side effects and can be prescribed for long-term administration.
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Affiliation(s)
- Tatiana V Kirichenko
- Institute for Atherosclerosis Research, Skolkovo Innovative Center, 4-1-207, Osennaya Str., 121609, Moscow, Russia.
| | - Igor A Sobenin
- Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315, Moscow, Russia; Russian Cardiology Research and Production Complex, 15-a 3rd Cherepkovskaya Str., 121552, Moscow, Russia
| | - Dragana Nikolic
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, 141 Via del Vespro, 90127, Palermo, Italy
| | - Manfredi Rizzo
- Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, 141 Via del Vespro, 90127, Palermo, Italy; Euro-Mediterranean Institute of Science and Technology, Via Emerico Amari 123, 90139, Palermo, Italy
| | - Alexander N Orekhov
- Institute for Atherosclerosis Research, Skolkovo Innovative Center, 4-1-207, Osennaya Str., 121609, Moscow, Russia; Institute of General Pathology and Pathophysiology, 8 Baltiyskaya Str., 125315, Moscow, Russia
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14
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Effect of intensive lipid-lowering therapies on cholinesterase activity in patients with coronary artery disease. Pharmacol Rep 2016; 69:150-155. [PMID: 27923158 DOI: 10.1016/j.pharep.2016.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many disease entities, including coronary artery disease (CAD), demonstrate abnormalities in the activity of cholinesterases. As CAD is characterized by an increase in cholesterol level, patients with this disease are treated with lipid-lowering drugs. The present study attempts to determine how statin or combined statin and ezetimibe therapy influences cholinesterase activity. METHODS Plasma and erythrocytes were isolated from the peripheral blood of CAD patients (n=61) and healthy subjects (n=63). The patients were randomized into three groups: 20mg/day rosuvastatin, 40mg/day atorvastatin, and combined 10mg/day atorvastatin with 10mg/day ezetimibe. The following parameters were studied: activity of acetylcholinesterase (AChE) and butyrylcholinoesterase (BChE) and lipid levels. RESULTS Patients with CAD demonstrated significant increase in AChE and BChE activity. We observed increase in the level of low-density lipoprotein cholesterol (LDL) and triglycerides (TG) level, and decrease in high density lipoprotein cholesterol (HDL) level. After atorvastatin monotherapy, the following decrease in activity were observed: 17% LDL, 43% total cholesterol (TC) level, 33% AChE and 17% BChE. The following decrease in activity were observed following rosuvastatin monotherapy: 26% LDL level, 26% AChE and 18% BChE. After combined atorvastatin+ezetimibe therapy, the following decrease in activity occurred: 27% of LDL level, 15% TC, 33% of AChE and 20% BChE. CONCLUSIONS Our results suggest that intensive lipid-lowering therapy has a beneficial effect on AChE and BChE activity and lipid levels. Combination atorvastatin+ezetimibe therapy was found to have similar effects on the tested parameters as statin monotherapy.
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15
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Eisen A, Cannon CP, Blazing MA, Bohula EA, Park JG, Murphy SA, White JA, Giugliano RP, Braunwald E. The benefit of adding ezetimibe to statin therapy in patients with prior coronary artery bypass graft surgery and acute coronary syndrome in the IMPROVE-IT trial. Eur Heart J 2016; 37:3576-3584. [PMID: 27569841 DOI: 10.1093/eurheartj/ehw377] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/08/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023] Open
Abstract
AIMS To examine the efficacy and safety of ezetimibe added to statin in patients with prior coronary artery bypass graft surgery (CABG) following hospitalization for an acute coronary syndrome (ACS). METHODS AND RESULTS In the IMPROVE-IT trial, post-ACS patients with mean low density lipoprotein cholesterol (LDL-C) of 93.8 mg/dL at presentation were randomized to simvastatin/ezetimibe or simvastatin/placebo. The primary endpoint was cardiovascular death, major coronary event or stroke, and the median follow-up was 6 years. Efficacy and safety endpoints were examined by prior CABG status. Among 18 134 patients, 1684 (9.3%) had a prior CABG (median age 69 years, 82% male). During the trial, the median time-weighted LDL-C level was 55.0 mg/dL with simvastatin/ezetimibe vs. 69.9 mg/dL with simvastatin/placebo in patients with prior CABG (P < 0.001), and it was 53.6 mg/dL vs. 69.5 mg/dL, respectively, in patients without prior CABG (P < 0.001). The rate of the primary endpoint was higher in patients with vs. without prior CABG [56% vs. 32%, adj. hazard ratio 1.45, 95% confidence interval (CI) 1.33-1.58]. Patients with prior CABG receiving simvastatin/ezetimibe had an 8.8% (95% CI 3.1-14.6%) lower absolute risk over simvastatin/placebo in the primary endpoint, whereas patients without prior CABG had a 1.3% (95% CI 0-2.6%) lower absolute risk (P-interaction = 0.02). There were no between-group significant differences in safety endpoints. CONCLUSION The clinical benefit of adding ezetimibe to statin appears to be enhanced in patients with prior CABG, supporting the use of intensive lipid lowering therapy in these high-risk patients following ACS.
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Affiliation(s)
- Alon Eisen
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | - Christopher P Cannon
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | | | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | - Jeong-Gun Park
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | - Sabina A Murphy
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | | | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
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16
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Abstract
Advances in atherosclerosis imaging technology and research have provided a range of diagnostic tools to characterize high-risk plaque in vivo; however, these important vascular imaging methods additionally promise great scientific and translational applications beyond this quest. When combined with conventional anatomic- and hemodynamic-based assessments of disease severity, cross-sectional multimodal imaging incorporating molecular probes and other novel noninvasive techniques can add detailed interrogation of plaque composition, activity, and overall disease burden. In the catheterization laboratory, intravascular imaging provides unparalleled access to the world beneath the plaque surface, allowing tissue characterization and measurement of cap thickness with micrometer spatial resolution. Atherosclerosis imaging captures key data that reveal snapshots into underlying biology, which can test our understanding of fundamental research questions and shape our approach toward patient management. Imaging can also be used to quantify response to therapeutic interventions and ultimately help predict cardiovascular risk. Although there are undeniable barriers to clinical translation, many of these hold-ups might soon be surpassed by rapidly evolving innovations to improve image acquisition, coregistration, motion correction, and reduce radiation exposure. This article provides a comprehensive review of current and experimental atherosclerosis imaging methods and their uses in research and potential for translation to the clinic.
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Affiliation(s)
- Jason M Tarkin
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Marc R Dweck
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Nicholas R Evans
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Richard A P Takx
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Adam J Brown
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Ahmed Tawakol
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - Zahi A Fayad
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.)
| | - James H F Rudd
- From the Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK (J.M.T., A.J.B., J.H.F.R.); Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK (N.R.E.); Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom (M.R.D); Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA (R.A.P.T., A.T.); Imaging Sciences Laboratories, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F., M.R.D.); and Department of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (Z.A.F.).
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17
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Abstract
Statins remain the mainstay of medical cardiovascular risk reduction because of their effectiveness in decreasing low-density lipoprotein cholesterol (LDL-C) as well as some other potentially beneficial effects. The latest US 2013 lipid guidelines essentially recommend only the prescription of a high-dose statin for the high-risk patient. However, both quite old and quite new outcomes evidence, such as reported for ezetimibe, emphasize that LDL-C lowering is, in and of itself, quite important for cardiovascular risk reduction. It appears that the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent a major new contribution to this effort, especially for patients with severe familial hypercholesterolemia, proven clinical cardiovascular disease, statin intolerance, or failure to attain an acceptably low LDL-C goal despite maximum available medical management. Very recent clinical trials have proven overwhelmingly the effectiveness and safety of PCSK9 inhibitors for lowering LDL-C. Both alirocumab and evolocumab have now been approved by the US FDA and there are some initial favorable outcomes data. This review is intended to summarize available evidence and emphasize the possible clinical role of these inhibitors following the approval of alirocumab and evolocumab. Understanding the negative receptor feedback of PCSK9 and the mechanism and beneficial effect of PCSK9 inhibitors for cardiovascular risk reduction is essential for the up-to-date practitioner of cardiovascular medicine. There is every reasonable hope for significant cardiovascular benefit from these new additions to our medical cardiovascular armamentarium.
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Reply to comment on: Effects of ezetimibe/simvastatin combination on metabolic parameters by Prof. Moses S Elisaf. Int J Cardiol 2016; 202:154-5. [PMID: 26397402 DOI: 10.1016/j.ijcard.2015.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022]
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Koh KK. Intriguing Off-Target Effects of Ezetimibe. J Am Coll Cardiol 2015; 66:2808. [PMID: 26700841 DOI: 10.1016/j.jacc.2015.08.1130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
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