Differential effects of fluvastatin alone or in combination with ezetimibe on lipoprotein subfractions in patients at high risk of coronary events

Stojaković, Tatjana; Campo, A. De; Scharnagl, Hubert; Sourij, Harald; Schmölzer, Isabella; Wascher, Thomas C.; März, Winfried

doi:10.1111/j.1365-2362.2009.02249.x

Cited by 17 publications

(16 citation statements)

References 35 publications

(45 reference statements)

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“…They have increased endothelial permeability, an augmented ability to bind to proteoglycans in the vessel wall, and undergo easier oxidation and glycation. Findings by other groups [11,12] further support the view that it may not be in the best interest of our patients to focus only on attaining a low LDL concentration, irrespective of the drugs used to get there. Maybe in the future, we should measure the subfractions of LDL.…”

supporting

confidence: 69%

Intensified Lipid-Lowering Therapy in Coronary Heart Disease: Is the Concept of “the Lower the Better” Evidence Based?

Erdmann

2010

Curr Treat Options Cardio Med

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supporting

confidence: 69%

Intensified Lipid-Lowering Therapy in Coronary Heart Disease: Is the Concept of “the Lower the Better” Evidence Based?

Erdmann

2010

Curr Treat Options Cardio Med

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“…The proportion of patients with Pattern B in those administered ezetimibe and fenofibrate is reduced as well[31,32]. In prior studies with ezetimibe monotherapy, or ezetimibe combined with statins, LDL particle size was either increased,[33] remained the same,[34] or decreased[35]. …”

Section: Discussionmentioning

confidence: 99%

“…So while the cholesterol from all LDL subclasses is reduced, the cholesterol carried by the larger particles may be preferentially reduced, resulting in a disproportionate number of small, denser particles left uncleared, and thus resulting in a post-treatment shift to Pattern B. It is also possible that once LDL-C is rendered below 100 mg/dL, the incorporation of cholesterol into larger LDL particles is reduced[35,38]. …”

Section: Discussionmentioning

confidence: 99%

Are post-treatment low-density lipoprotein subclass pattern analyses potentially misleading?

Bays

Conard²,

Leiter

et al. 2010

Lipids Health Dis

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BackgroundSome patients administered cholesterol-lowering therapies may experience an increase in the proportion of small LDL particles, which may be misinterpreted as a worsening of atherosclerotic coronary heart disease risk. This study assessed the lipid effects of adding ezetimibe to atorvastatin or doubling the atorvastatin dose on low-density lipoprotein cholesterol (LDL-C) levels (and the cholesterol content of LDL subclasses), LDL particle number (approximated by apolipoprotein B), and LDL particle size. This was a multicenter, double-blind, randomized, parallel-group study of hypercholesterolemic, high atherosclerotic coronary heart disease risk patients. After stabilization of atorvastatin 40 mg, 579 patients with LDL-C >70 mg/dL were randomized to 6 weeks of ezetimibe + atorvastatin 40 mg or atorvastatin 80 mg. Efficacy parameters included changes from baseline in LDL-C, apolipoprotein B, non-high-density lipoprotein cholesterol (non-HDL-C), and lipoprotein subclasses (Vertical Auto Profile II) and pattern for the overall population, as well as patient subgroups with baseline triglyceride levels <150 mg/dL or ≥150 mg/dL.ResultsBoth treatments significantly reduced LDL-C (and the cholesterol content of most LDL subfractions [LDL1-4]) apolipoprotein B, non-HDL-C levels, but did not reduce the proportion of smaller, more dense LDL particles; in fact, the proportion of Pattern B was numerically increased. Results were generally similar in patients with triglyceride levels <150 or ≥150 mg/dL.ConclusionsWhen assessing the effects of escalating cholesterol-lowering therapy, effects upon Pattern B alone to assess coronary heart disease risk may be misleading when interpreted without considerations of other lipid effects, such as reductions in LDL-C, atherogenic lipoprotein particle concentration, and non-HDL-C levels.Trial Registration(Registered at clinicaltrials.gov: Clinical trial # NCT00276484)

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“…Some studies reported that combination therapy has been effective at improving LDL size in people with T2D [46]. However, some recent randomized trials showed no further improvements in CVD risk by using the combined therapy over monotherapy [47,48]. Furthermore, combined therapy may increase the risk of myopathy.…”

Section: Discussionmentioning

confidence: 99%

Low Plasma Hdl Cholesterol and Elevated C Reactive Protein further Increase Cardiovascular Disease Risk in Latinos with Type 2 Diabetes

Calle

Vega‐López²,

Segura-Pérez³

et al. 2010

J Diabet Metabol

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Differential effects of fluvastatin alone or in combination with ezetimibe on lipoprotein subfractions in patients at high risk of coronary events

Abstract: Addition of ezetimibe to fluvastatin resulted in a further reduction of buoyant and intermediate, but not of dense LDL compared with fluvastatin alone.

Cited by 17 publications

References 35 publications

Intensified Lipid-Lowering Therapy in Coronary Heart Disease: Is the Concept of “the Lower the Better” Evidence Based?

Intensified Lipid-Lowering Therapy in Coronary Heart Disease: Is the Concept of “the Lower the Better” Evidence Based?

Are post-treatment low-density lipoprotein subclass pattern analyses potentially misleading?

Low Plasma Hdl Cholesterol and Elevated C Reactive Protein further Increase Cardiovascular Disease Risk in Latinos with Type 2 Diabetes

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