Pleiotropic effects of ezetimibe/simvastatin vs. high dose simvastatin

Author(s)

Pesaro, Antonio Eduardo P. ^[1] ; Serrano, Jr., Carlos V. ; Fernandes, Juliano L. ^[3] ; Cavalcanti, Alexandre B. ^[4] ; Campos, Alexandre H. ^[5] ; Martins, Herlon S. ^[6] ; Maranhao, Raul C. ^[7] ; de Lemos, James A. ^[8] ; Souza, Heraldo P. ^[9] ; Nicolau, Jose C. ^[10]

Affiliation

^[1] Univ Sao Paulo. Inst Heart

^[3] Univ Sao Paulo. Inst Heart

^[4] Hosp Coracao HCor. Res Inst

^[5] Albert Einstein Hosp. Sao Paulo

^[6] Univ Sao Paulo. Clin Hosp

^[7] Univ Sao Paulo. Inst Heart

^[8] Univ Texas SW Med Ctr Dallas. Dallas

^[9] Univ Sao Paulo. Clin Hosp

^[10] Univ Sao Paulo. Inst Heart

• Document type: Journal article
• Source: INTERNATIONAL JOURNAL OF CARDIOLOGY; v. 158, n. 3, p. 400-404, JUL 26 2012.
• Web of Science Citations: 26

Abstract

Background: In the setting of stable coronary artery disease (CAD), it is not known if the pleiotropic effects of cholesterol reduction differ between combined ezetimibe/simvastatin and high-dose simvastatin alone. Objective: We sought to compare the anti-inflammatory and antiplatelet effects of ezetimibe 10 mg/simvastatin 20 mg (E10/S20) with simvastatin 80 mg (S80). Methods and results: CAD patients (n = 83, 63 +/- 9 years, 57% men) receiving S20, were randomly allocated to receive E10/S20 or S80, for 6 weeks. Lipids, inflammatory markers (C-reactive protein, interleukin-6, monocyte chemoattractant protein-1, soluble CD40 ligand and oxidized LDL), and platelet aggregation (platelet function analyzer {[}PFA]-100) changes were determined. Baseline lipids, inflammatory markers and PFA-100 were similar between groups. After treatment, E10/S20 and S80 patients presented, respectively: (1) similar reduction in LDL-C (29 +/- 13% vs. 28 +/- 30%, p = 0.46), apo-B (18 +/- 17% vs. 22 +/- 15%, p = 0.22) and oxidized LDL (15 +/- 33% vs. 18 +/- 47%, p = 0.30); (2) no changes in inflammatory markers; and, (3) a higher increase of the PFA-100 with E10/S20 than with S80 (27 +/- 43% vs. 8 +/- 33%, p = 0.02). Conclusions: These data suggest that among stable CAD patients treated with S20, (1) both E10/S20 and S80 were equally effective in further reducing LDL-C; (2) neither treatment had any further significant anti-inflammatory effects; and (3) E10/S20 was more effective than S80 in inhibiting platelet aggregation. Thus, despite similar lipid lowering and doses 4x less of simvastatin, E10/S20 induced a greater platelet inhibitory effect than S80. (C) 2011 Elsevier Ireland Ltd. All rights reserved. (AU)