Effect of ezetimibe/simvastatin vs atorvastatin on lowering levels of LDL-C and non–HDL-C, ApoB, and hs-CRP in patients with type 2 diabetes

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• 作者：Ruth S. Weinstock ; Ronald B. Goldberg ; John R. Guyton ; Theodore Mazzone ; Adam Polis ; Joanne E. Tomassini ; Jianxin Lin ; Arvind Shah ; Andrew M. Tershakovec
• 关键词：ApoB ; Atorvastatin ; Ezetimibe/simvastatin ; Hs-CRP ; LDL-C ; Non– ; HDL-C
• 刊名：Journal of Clinical Lipidology
• 出版年：2008
• 出版时间：February 2008
• 年：2008
• 卷：2
• 期：1
• 页码：25-35
• 全文大小：294 K

文摘

Background

In addition to low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non–HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hs-CRP) are considered predictive for cardiovascular disease in type 2 diabetes mellitus (T2DM) patients.

Objective

To assess the proportion of T2DM patients with hypercholesterolemia who attained the optional target level of LDL-C (<70 mg/dL) and additionally non–HDL-C (<100 mg/dL), ApoB (<90 mg/dL), and hs-CRP (<2 mg/L), following treatment with ezetimibe/simvastatin (E/S) vs atorvastatin (A).

Methods

This post-hoc analysis of a multicenter, randomized, double-blind, 6-week parallel study assessed the proportion of T2DM patients who attained specified LDL-C levels and non–HDL-C, ApoB, and hs-CRP with usual, recommended starting doses of E/S (10/20 mg) vs A (10 or 20 mg) and next highest doses of E/S (10/40 mg) vs A (40 mg) by logistic regression. Baseline triglyceride and hs-CRP effects were also evaluated.

Results

Significantly higher percentages of patients treated with E/S compared to A achieved individual and concurrent target levels of LDL-C (<70 mg/dL), non–HDL-C (<100 mg/dL), and ApoB (<90 mg/dL) at all dose comparisons (P < 0.05 to P < 0.001). Baseline triglyceride levels had no effect on reaching LDL-C levels. Attainment of non–HDL-C (<100 mg/dL), and ApoB (<90 mg/dL) was lower at triglycerides ≥200 mg/dL than <200 mg/dL. Achievement of hs-CRP level (<2 mg/L) was comparable for both treatments. Significantly more patients attained both LDL-C (<70 mg/dL) and hs-CRP (<2 mg/L) at all E/S doses compared to A (P < 0.05 to P < 0.001), regardless of baseline CRP levels.

Conclusion

E/S provides a therapeutic option to T2DM patients for lowering not only LDL-C, but also non–HDL-C, ApoB, and hs-CRP. These factors may help guide assessment and treatment of cardiovascular disease risk in these patients.