Effects of ezetimibe/simvastatin 10/10 mg versus Rosuvastatin 10 mg on carotid atherosclerotic plaque inflammation

Abstract

Background: Using 18 F-fluorodeoxyglucose ( 18 FDG) positron emission tomography-computed tomography (PET/CT) imaging, we examined the effects of ezetimibe/simvastatin 10/10 mg versus rosuvastatin 10 mg on carotid atherosclerotic plaque inflammation. Whether the combination therapy of ezetimibe with low-dose statin is as effective as potent statin monotherapy in attenuating carotid atherosclerotic plaque inflammation remains unclear.Methods: In this 2-by-2 factorial trial, 50 patients with 18 FDG uptake (target-to-background ratio [TBR] ≥1.6) in the carotid artery and acute coronary syndrome were randomized to receive either simvastatin/ezetimibe 10/10 mg or rosuvastatin 10 mg. 18 FDG PET/CT examinations were performed at baseline and at 6 months. The percent change in the TBR of the index vessel at the most diseased segment (MDS) was the primary endpoint. Results: Baseline characteristics of the two groups were largely similar. At 6-month follow-up, the MDS TBR of the index vessel and aorta significantly decreased in ezetimibe/simvastatin group and tended to decrease in rosuvastatin group. However, the percent change in the MDS TBR of the index vessel was similar between the 2 groups (− 10.22 ± 17.49% vs.-5.84 ± 15.78%, respectively, p = 0.357), as was the percent change in the whole vessel TBR of the index vessel. Likewise, the changes in the MDS TBR or whole vessel TBR of the aorta were similar in both groups. Total cholesterol and lowdensity lipoprotein cholesterol levels improved to a similar degree in both groups. Conclusion: Treatment with ezetimibe/simvastatin versus rosuvastatin resulted in a similar improvement of carotid atherosclerotic plaque inflammation, suggesting their equivalent anti-inflammatory effects. Trial registration: The trial is registered at ClinicalTrials.

Carotid Artery Temperature Reduction with Statin Therapy in Patients with Familial Hyperlipidemia Syndromes

“…Our findings suggest that statin therapy, either alone or in combination with ezetimibe, significantly reduced carotid temperatures in those patients. This is in line with recent studies, where both statin monotherapy and the combination of ezetimibe with either simvastatin or rosuvastatin reduced FDG carotid wall uptake in patients with recent acute coronary syndrome [ 14 , 15 ].…”

“…Although robust data exist about the impact of statin therapy on carotid wall inflammation [ 16 , 17 , 18 ], few data exist regarding the impact of ezetimibe on top of statin therapy on arterial wall inflammatory activation. In specific, the combination of ezetimibe with statin, compared to statin monotherapy, exerts a similar anti-inflammatory effect on carotid atherosclerotic plaque [ 14 , 15 ]. It is noteworthy that in a recent study the combination of ezetimibe with low-dose rosuvastatin showed inferior carotid wall anti-inflammatory effect compared to high-dose rosuvastatin [ 19 ].…”

Statin/ezetimibe combination therapy vs statin monotherapy for carotid atherosclerotic plaque inflammation

“…Acute coronary syndrome including ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, and unstable angina was diagnosed based on the clinical symptoms, electrocardiography, and a rise in troponins. The trials used a common protocol with the only exception being the cholesterol-lowering medications; the effects of simvastatin/ezetimibe 10 mg/10 mg vs rosuvastatin 10 mg, [ 17 ] and rosuvastatin/ezetimibe 5 mg/10 mg vs rosuvastatin 20 mg on carotid atherosclerotic plaque inflammation were compared. [ 18 ] In each of these studies, patients were required to have carotid artery disease (diameter of stenosis, 20%–50%), acute coronary syndrome, and at least one carotid 18 FDG uptake lesion (target-to-background ratio (TBR) ≥ 1.6).…”

A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review

“…In other words, PET/CT can detect even small changes in arterial wall inflammation, which is a unique property among other imaging techniques or biomarkers. So far, seven prospective studies have used scintigraphy to evaluate the impact of statins on carotid plaque inflammation by measuring target-to-background ratio (TBR) (n = 5 studies) [45][46][47][48] and/or standardized uptake value (SUV) (n = 3 studies) [39,49,50]. Most of them supported a significant reduction of arterial wall inflammation after either 3-month atorvastatin (10-80 mg/d) [46,[48][49][50] therapy, or 1-month atorvastatin (20 mg/d) [45] administration, or 6-month therapy with either simvastatin (10 mg/d), rosuvastatin (10 mg/d) [39], pitavastatin (2 mg/d), or pravastatin (10 mg/d) [39].…”