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

Abstract

It remains uncertain whether statin/ezetimibe combination therapy serves as a useful and equivalent alternative to statin monotherapy for reducing atherosclerotic plaque inflammation. The aim of the present study was to compare the effects of statin/ezetimibe combination therapy and statin monotherapy on carotid atherosclerotic plaque inflammation using 18 F-fluorodeoxyglucose ( 18 FDG) positron emission tomography (PET)/computed tomography (CT) imaging. Data were pooled from 2 clinical trials that used serial 18 FDG PET/CT examination to investigate the effects of cholesterol-lowering therapy on carotid atherosclerotic plaque inflammation. The primary outcome was the percent change in the target-to-background ratio (TBR) of the index vessel in the most diseased segment (MDS) at 6-month follow-up. Baseline characteristics were largely similar between the 2 groups. At the 6-month follow-up, the MDS TBR of the index vessel significantly decreased in both groups. The percent change in the MDS TBR of the index vessel (primary outcome) did not differ significantly between the 2 groups (−8.41 ± 15.9% vs −8.08 ± 17.0%, respectively, P = .936). Likewise, the percent change in the whole vessel TBR of the index vessel did not differ significantly between the 2 groups. There were significant decreases in total and LDL cholesterol levels in both groups at follow-up ( P < .001). There were no significant correlations between the percent changes in MDS TBR of the index vessel, changes in the lipid, and high-sensitive C-reactive protein levels. The reduction in carotid atherosclerotic plaque inflammation by statin/ezetimibe combination therapy was equivalent to that by the statin monotherapy.

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 ].…”

Emerging Non-statin Treatment Options for Lowering Low-Density Lipoprotein Cholesterol

“…Several studies following IMPROVE-IT have found that the benefits of concomitant ezetimibe and statin therapies were greatest in patients at high-risk of ASCVD ( 27 – 29 ). The ASCVD risk reduction seen with ezetimibe may not only be due to the LCL-C reduction, but also due to reduction of inflammation ( 30 ). Oh et al have revealed that an ezetimibe/statin regimen (ezetimibe 10 mg/simvastatin 10 mg and ezetimibe 10 mg/rosuvastatin 5 mg) reduces carotid atherosclerotic plaque inflammation to a similar extent compared to statin monotherapy (rosuvastatin 10 mg and rosuvastatin 20 mg) ( 30 ).…”

“…The ASCVD risk reduction seen with ezetimibe may not only be due to the LCL-C reduction, but also due to reduction of inflammation ( 30 ). Oh et al have revealed that an ezetimibe/statin regimen (ezetimibe 10 mg/simvastatin 10 mg and ezetimibe 10 mg/rosuvastatin 5 mg) reduces carotid atherosclerotic plaque inflammation to a similar extent compared to statin monotherapy (rosuvastatin 10 mg and rosuvastatin 20 mg) ( 30 ). Masson et al support this finding by demonstrating the addition of ezetimibe to statin therapy led to a reduction of coronary atherosclerosis ( 31 ).…”

Cholesterol-lowering drugs: Focus on Ezetimibe: Cholesterol-lowering drugs: Focus on ezetimibe

“…Another study compared the effects of ezetimibe/statin combination therapy (ezetimibe/simvastatin 10 mg or ezetimibe/rosuvastatin 5 mg) and statin monotherapy (rosuvastatin 10 mg or 20 mg) on carotid atherosclerotic plaque inflammation in patients with mild carotid atherosclerosis and acute coronary syndrome (59). LDL-C levels were substantially and similarly reduced in both groups at follow-up, and atherosclerotic plaque inflammation of the carotid artery and aorta evaluated decreased similarly with both treatments, which suggests that an ezetimibe/statin combination therapy may provide anti-inflammatory effects comparable to statin monotherapy at equivalent LDL-C-lowering doses (59).…”