Document Detail


The effect of ezetimibe on peripheral arterial atherosclerosis depends upon statin use at baseline.
MedLine Citation:
PMID:  21570685     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Both statins and ezetimibe lower LDL-C, but ezetimibe's effect on atherosclerosis is controversial. We hypothesized that lowering LDL-C cholesterol by adding ezetimibe to statin therapy would regress atherosclerosis measured by magnetic resonance imaging (MRI) in the superficial femoral artery (SFA) in peripheral arterial disease (PAD).
METHODS: Atherosclerotic plaque volume was measured in the proximal 15-20 cm of the SFA in 67 PAD patients (age 63 ± 10, ABI 0.69 ± 0.14) at baseline and annually × 2. Statin-naïve patients (n=34) were randomized to simvastatin 40 mg (S, n=16) or simvastatin 40 mg+ezetimibe 10mg (S+E, n=18). Patients already on statins but with LDL-C >80 mg/dl had open-label ezetimibe 10mg added (E, n=33). Repeated measures models estimated changes in plaque parameters over time and between-group differences.
RESULTS: LDL-C was lower at year 1 in S+E (67 ± 7 mg/dl) than S (91 ± 8 mg/dl, p<0.05), but similar at year 2 (68 ± 10 mg/dl vs. 83 ± 11 mg/dl, respectively). Plaque volume did not change from baseline to year 2 in either S+E (11.5 ± 1.4-10.5 ± 1.3 cm(3), p=NS) or S (11.0 ± 1.5-10.5 ± 1.4 cm(3), p=NS). In E, plaque progressed from baseline to year 2 (10.0 ± 0.8-10.8 ± 0.9, p<0.01) despite a 22% decrease in LDL-C.
CONCLUSIONS: Statin initiation with or without ezetimibe in statin-naïve patients halts progression of peripheral atherosclerosis. When ezetimibe is added to patients previously on statins, peripheral atherosclerosis progressed. Thus, ezetimibe's effect on peripheral atherosclerosis may depend upon relative timing of statin therapy.
Authors:
Amy M West; Justin D Anderson; Craig H Meyer; Frederick H Epstein; Hongkun Wang; Klaus D Hagspiel; Stuart S Berr; Nancy L Harthun; Joseph M DiMaria; Jennifer R Hunter; John M Christopher; Joshua D Chew; Gabriel B Winberry; Christopher M Kramer
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural     Date:  2011-04-16
Journal Detail:
Title:  Atherosclerosis     Volume:  218     ISSN:  1879-1484     ISO Abbreviation:  Atherosclerosis     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-09-05     Completed Date:  2012-04-05     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  0242543     Medline TA:  Atherosclerosis     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  156-62     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00587678
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MeSH Terms
Descriptor/Qualifier:
Aged
Anticholesteremic Agents / therapeutic use
Atherosclerosis / drug therapy*
Azetidines / administration & dosage*
Cholesterol, LDL / blood
Double-Blind Method
Female
Femoral Artery / drug effects
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Magnetic Resonance Imaging / methods
Male
Middle Aged
Peripheral Arterial Disease / drug therapy*
Plaque, Atherosclerotic / drug therapy
Prospective Studies
Simvastatin / administration & dosage
Treatment Outcome
Grant Support
ID/Acronym/Agency:
M01RR000847/RR/NCRR NIH HHS; R01 HL075792/HL/NHLBI NIH HHS; R01 HL075792/HL/NHLBI NIH HHS; R01 HL075792-05/HL/NHLBI NIH HHS; T32 EB003841/EB/NIBIB NIH HHS; T32 EB003841/EB/NIBIB NIH HHS; T32 EB003841-05/EB/NIBIB NIH HHS
Chemical
Reg. No./Substance:
0/Anticholesteremic Agents; 0/Azetidines; 0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 163222-33-1/ezetimibe; AGG2FN16EV/Simvastatin
Comments/Corrections
Comment In:
Atherosclerosis. 2011 Sep;218(1):23-5   [PMID:  21704315 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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