Efficacy of combination therapy with ezetimibe and statins versus a double dose of statin monotherapy in participants with hypercholesterolemia: a meta-analysis of literature

Abstract

Background: The aim of this study was to compare and summarize the lipid-altering effects of combination therapy with ezetimibe and statins (E/S) and a double dose of statin (D/S) monotherapy on patients with hypercholesterolemia. Methods: We conducted search on 2 medical databases, PubMed and EMBASE to identify all relevant studies. A meta-analysis was performed to clarify the efficacy in the two groups. Only double-blind Randomized controlled study (RCTs) of efficacy evaluation in the two groups with ezetimibe and statins and a double dose of statin in participants with hypercholesterolemia that examined low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and high-density lipoprotein (HDL) were included. Two reviewers extracted data from all primary studies independently. The primary data were the level of LDL-C, TC and HDL-C concentrations at the end point and are expressed as mean and standard deviation (SD). Results: A total of 11 double-blind, active or placebo-controlled studies with 1926 hypercholesterolemia adults randomized to ezetimibe 10 mg added to ongoing statins (N = 994) or statin titration (doubling) (N = 932) were pooled for the global meta-analysis. The effect size between treatment groups within individual studies was assessed by weighted mean difference (MD) using a random-or fixed-effect model. The result showed that the participants in E/S group get obvious lower LDL-C [MD =-13.14 mg/dL, 95%CI (−16.83,-9.44), p = 0.00001] and TC concentration [MD =-23.79 mg/dL, 95%CI (−38.65,-8.93), p = 0.002] from baseline to follow-up, comparing to the D/ S group. Besides, no significant between-group differences were observed for concentrations of HDL-C [MD = 0.46 mg/dL, 95%CI (− 1.14, 2.06), p = 0.57]. According to subgroup analysis, the combination of ezetimibe and atorvastatin (10 mg) [MD =-16.98 mg/dL, p < 0 .0001] or simvastatin (20 mg) [MD =-17.35 mg/dL, p < 0 .0001] showed stronger ability of reducing LDL-C than combination of ezetimibe and rosuvastatin (10 mg) [MD =-9.29 mg/dL, p = 0.05]. The efficacy of short-term (endpoint time between 6 to 16 week) and long-term (52 week) treatment in the LDL-C between two groups did not show significant differences. Besides, only participants from Asia treated with combination therapy were associated with a significant lower LDL-C concentration [MD =-14.7 mg/dL, p < 0 .0001].

The prevalence of hypercholesterolemia and associated risk factors in Al-Kharj population, Saudi Arabia: a cross-sectional survey

“…Furthermore, the current study found a higher prevalence of hypercholesterolemia among diabetic participants. A recently published Berlin Aging Study II (BASEII) found that elderly individuals on lipid lowering medication had a higher prevalence of diabetes [ 10 ]. However, most published studies have reported a higher prevalence of HC among diabetic individuals [ 27 , 37 ].…”

“…Age is also a strong risk factor for HC; more advanced age has been associated with higher risk of HC for both sexs [ 7 – 9 ]. In people who are in younger age groups (teenagers, young adults 18–25 years of age), HC can go undetected [ 10 ]. In a study by Basulaiman et al, it was reported that 65% of Saudis with HC were undiagnosed [ 9 ].…”

“…In a study by Basulaiman et al, it was reported that 65% of Saudis with HC were undiagnosed [ 9 ]. Another study reported that the prevalence of HC was 23.7% in the young age group [ 10 ]. There is currently a gap in the literature when it comes to HC, as there is a very limited number of studies which include young adults (18–25 years of age) [ 9 , 11 , 12 ].…”

Leptin System in Obese Dog Skin: A Pilot Study

“…It can be supposed that the LEP receptor changes its expression following the stimulation of the increased plasma LEP since hormone local production was not changed. The increased LEPR expression observed in the Obese group suggests that the receptor plays a modulating role in the skin system control and that serum LEP may have a role in the pathogenesis of skin disease associated with obesity [ 61 ]. However, Arnold et al [ 62 ] have shown that among the different isoforms of LEPR (LEPRa, b, c, d, f: transmembrane), there is also a soluble form of the LEP receptor (LEPRe) capable of modulating the bio-availability and the consequent action of LEP.…”

<p>Role of Caspase-1 in the Pathogenesis of Inflammatory-Associated Chronic Noncommunicable Diseases</p>

“… 47 , 48 Therefore, inflammasome-mediated activation of caspase-1 and its target substrates are physiologically important to regulate immune cell response against microbial infections and metabolic activities. 32 , 49 However, infection resistance or obesity-associated chronic inflammation in peripheral tissues can lead to metabolic disturbances such as obesity, type two diabetes mellitus (T2DM), insulin resistance and cardiovascular diseases. 50 Chronic inflammation is usually associated with the release of oxidative metabolic intermediates like ROS, which in turn leads to organelle dysfunctions, including mitochondrial dysfunction.…”