Influence of metabolic syndrome factors and insulin resistance on the efficacy of ezetimibe/simvastatin and atorvastatin in patients with metabolic syndrome and atherosclerotic coronary heart disease risk.

Abstract

BACKGROUND:

Metabolic syndrome (MetS) and insulin resistance (IR) are increasing in prevalence, are associated with higher risk for coronary heart disease (CHD), and may potentially influence the responses to lipid-altering drug therapy. This study evaluated the effects of MetS factors (abdominal obesity, depleted high-density lipoprotein cholesterol [HDL-C], and elevated triglycerides, blood pressure, and fasting glucose) and IR on ezetimibe/simvastatin and atorvastatin treatment efficacy in patients with MetS.

METHODS:

This post-hoc analysis of a multicenter, 6-week, double-blind, randomized, parallel group study of 1128 subjects with hypercholesterolemia, MetS, and moderately high/high CHD risk evaluated the effects of baseline MetS factors/IR on percent change from baseline in lipids, apolipoproteins, and high-sensitivity C-reactive protein (hs-CRP), after treatment with the usual starting doses of ezetimibe/simvastatin (10/20 mg) versus atorvastatin (10 mg, 20 mg) and next higher doses (10/40 mg versus 40 mg).

RESULTS:

Ezetimibe/simvastatin and atorvastatin efficacy was generally consistent across MetS factor/IR subgroups. Ezetimibe/simvastatin produced greater incremental percent reductions in LDL-C, non-HDL-C, apolipoprotein B, total cholesterol, and lipoprotein ratios for all subgroups, and larger percent increases in HDL-C and apolipoprotein AI for all but non-obese and HDL-C ≥ 40 mg/dL subgroups than atorvastatin at the doses compared. Triglycerides, very-LDL-C, and hs-CRP results were more variable but similar between treatment groups.

CONCLUSION:

The magnitude of lipid-altering effects produced by each treatment regimen was generally similar across all MetS and IR subgroups. Ezetimibe/simvastatin produced greater percent reductions in most lipid fractions than atorvastatin at the dose comparisons studied, and all treatments were generally well tolerated. (Registered at clinicaltrials.gov: NCT00409773).

• Authors: Jeffrey B Rosen, Christie M Ballantyne, Willa A Hsueh, Jianxin Lin, Arvind K Shah, Robert S Lowe, Andrew M Tershakovec
• Journal: Lipids in health and disease (Lipids Health Dis) Vol. 14 Pg. 103 (Sep 04 2015) ISSN: 1476-511X [Electronic] England
• PMID: 26336957 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anticholesteremic Agents
• Blood Glucose
• Cholesterol, LDL
• Lipoproteins, HDL
• Triglycerides
• C-Reactive Protein
• Atorvastatin
• Simvastatin
• Ezetimibe

Topics

• Aged
• Anticholesteremic Agents (therapeutic use)
• Atorvastatin (therapeutic use)
• Blood Glucose (metabolism)
• Blood Pressure
• C-Reactive Protein (metabolism)
• Cholesterol, LDL (blood)
• Coronary Artery Disease (blood, complications, pathology)
• Coronary Disease (blood, complications, drug therapy, pathology)
• Double-Blind Method
• Ezetimibe (therapeutic use)
• Female
• Humans
• Hypercholesterolemia (blood, complications, drug therapy, pathology)
• Insulin Resistance
• Lipoproteins, HDL (blood)
• Male
• Metabolic Syndrome (blood, complications, drug therapy, pathology)
• Middle Aged
• Obesity, Abdominal (blood, complications, pathology)
• Risk Factors
• Simvastatin (therapeutic use)
• Treatment Outcome
• Triglycerides (blood)