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Reaching goal in hypercholesterolaemia: dual inhibition of cholesterol synthesis and absorption with simvastatin plus ezetimibe.
Curr Med Res Opin 2006; 22(3):511-28CM

Abstract

Lowering serum cholesterol levels reduces the risk of coronary heart disease (CHD)-related events. Statins are commonly prescribed as first-line treatment but many patients at high-risk for CHD still fail to reach their cholesterol or low-density lipoprotein cholesterol (LDL-C) goals with statin monotherapy. National and international guidelines for the prevention of CHD recommend the modification of lipid profiles and particularly LDL-C [e.g. the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III; 2001) and Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (2003) Guidelines]. Several recent clinical trials indicated an added benefit from aggressive lowering of LDL-C levels. Based on these findings, the NCEP ATP III revised the LDL-C target from < 100 mg/dL (2.6 mmol/L) to < 70 mg/dL (1.8 mmol/L) (optional target) for very high-risk patients and < 130 mg/dL (3.4 mmol/L) to < 100 mg/dL (2.6 mmol/L) for moderately high-risk patients. For patients who fail to achieve their LDL-C target, inhibiting the two main sources of cholesterol - synthesis and uptake - can produce more effective lipid lowering, allowing more patients to reach their LDL-C goal. Ezetimibe is a highly-selective inhibitor of cholesterol absorption and simvastatin is an evidence-based inhibitor of cholesterol synthesis. The LDL-C-lowering efficacy of targeting both major sources of cholesterol with ezetimibe plus simvastatin was demonstrated in several multicentre, double-blind, placebo-controlled trials in patients with hypercholesterolaemia. For patients who do not reach their cholesterol goal with a statin, adding ezetimibe 10 mg significantly reduces LDL-C compared with statin monotherapy. Thus, this treatment option may help patients reach the new 'stricter' cholesterol goals. This review, based on a Medline database search from January 2000 to August 2005, considers the LDL-C-lowering efficacy of ezetimibe and discusses the role of this agent for patients who fail to achieve guideline cholesterol goals with statin monotherapy.

Authors+Show Affiliations

Department of Clinical Biochemistry, Royal Free Hospital, Royal Free and University College School of Medicine, London NW3 2QG, UK.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

16574035

Citation

Daskalopoulou, Stella S., and Dimitri P. Mikhailidis. "Reaching Goal in Hypercholesterolaemia: Dual Inhibition of Cholesterol Synthesis and Absorption With Simvastatin Plus Ezetimibe." Current Medical Research and Opinion, vol. 22, no. 3, 2006, pp. 511-28.
Daskalopoulou SS, Mikhailidis DP. Reaching goal in hypercholesterolaemia: dual inhibition of cholesterol synthesis and absorption with simvastatin plus ezetimibe. Curr Med Res Opin. 2006;22(3):511-28.
Daskalopoulou, S. S., & Mikhailidis, D. P. (2006). Reaching goal in hypercholesterolaemia: dual inhibition of cholesterol synthesis and absorption with simvastatin plus ezetimibe. Current Medical Research and Opinion, 22(3), pp. 511-28.
Daskalopoulou SS, Mikhailidis DP. Reaching Goal in Hypercholesterolaemia: Dual Inhibition of Cholesterol Synthesis and Absorption With Simvastatin Plus Ezetimibe. Curr Med Res Opin. 2006;22(3):511-28. PubMed PMID: 16574035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reaching goal in hypercholesterolaemia: dual inhibition of cholesterol synthesis and absorption with simvastatin plus ezetimibe. AU - Daskalopoulou,Stella S, AU - Mikhailidis,Dimitri P, PY - 2006/4/1/pubmed PY - 2006/8/11/medline PY - 2006/4/1/entrez SP - 511 EP - 28 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 22 IS - 3 N2 - Lowering serum cholesterol levels reduces the risk of coronary heart disease (CHD)-related events. Statins are commonly prescribed as first-line treatment but many patients at high-risk for CHD still fail to reach their cholesterol or low-density lipoprotein cholesterol (LDL-C) goals with statin monotherapy. National and international guidelines for the prevention of CHD recommend the modification of lipid profiles and particularly LDL-C [e.g. the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III; 2001) and Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice (2003) Guidelines]. Several recent clinical trials indicated an added benefit from aggressive lowering of LDL-C levels. Based on these findings, the NCEP ATP III revised the LDL-C target from < 100 mg/dL (2.6 mmol/L) to < 70 mg/dL (1.8 mmol/L) (optional target) for very high-risk patients and < 130 mg/dL (3.4 mmol/L) to < 100 mg/dL (2.6 mmol/L) for moderately high-risk patients. For patients who fail to achieve their LDL-C target, inhibiting the two main sources of cholesterol - synthesis and uptake - can produce more effective lipid lowering, allowing more patients to reach their LDL-C goal. Ezetimibe is a highly-selective inhibitor of cholesterol absorption and simvastatin is an evidence-based inhibitor of cholesterol synthesis. The LDL-C-lowering efficacy of targeting both major sources of cholesterol with ezetimibe plus simvastatin was demonstrated in several multicentre, double-blind, placebo-controlled trials in patients with hypercholesterolaemia. For patients who do not reach their cholesterol goal with a statin, adding ezetimibe 10 mg significantly reduces LDL-C compared with statin monotherapy. Thus, this treatment option may help patients reach the new 'stricter' cholesterol goals. This review, based on a Medline database search from January 2000 to August 2005, considers the LDL-C-lowering efficacy of ezetimibe and discusses the role of this agent for patients who fail to achieve guideline cholesterol goals with statin monotherapy. SN - 0300-7995 UR - https://www.unboundmedicine.com/medline/citation/16574035/Reaching_goal_in_hypercholesterolaemia:_dual_inhibition_of_cholesterol_synthesis_and_absorption_with_simvastatin_plus_ezetimibe_ L2 - http://www.tandfonline.com/doi/full/10.1185/030079906X89856 DB - PRIME DP - Unbound Medicine ER -