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Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy.
Vasc Health Risk Manag. 2013; 9:719-27.VH

Abstract

BACKGROUND

Many high-risk coronary heart disease (CHD) patients on statin monotherapy do not achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals, and combination lipid-lowering therapy may be considered for these individuals. The effect of adding ezetimibe to simvastatin, atorvastatin, or rosuvastatin therapy versus titrating these statins on LDL-C changes and goal attainment in CHD or CHD risk-equivalent patients was assessed in a large, managed-care database in the US.

METHODS

Eligible patients (n=17,830), initially on statin monotherapy who were ≥18 years with baseline and follow-up LDL-C values, no concomitant use of other lipid-lowering therapy, and on lipid-lowering therapy for ≥42 days, were identified between November 1, 2002 and September 30, 2009. The percent change from baseline in LDL-C levels and the odds ratios for attainment of LDL-C<1.8 and <2.6 mmol/L (70 and 100 mg/dL) were estimated using an analysis of covariance and logistic regression, respectively, adjusted for various baseline factors.

RESULTS

LDL-C reductions from baseline and goal attainment improved substantially in patients treated with ezetimibe added onto simvastatin, atorvastatin, or rosuvastatin therapy (n=2,312) versus those (n=13,053) who titrated these statins. In multivariable models, percent change from baseline in LDL-C was -13.1% to -14.8% greater for those who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus those who titrated. The odds of attaining LDL-C<1.8 and <2.6 mmol/L (70 and 100 mg/dL) increased by 2.6-3.2-fold and 2.5-3.1-fold, respectively, in patients who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus titrating statins.

CONCLUSION

CHD/CHD risk-equivalent patients in a large US managed-care database, who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin, had greater LDL-C reductions and goal attainment than those who uptitrated these statin therapies. Our study suggests that high-risk CHD patients in need of more intensive LDL-C lowering therapy may benefit by adding ezetimibe onto statin therapy.

Authors+Show Affiliations

Brigham and Women's Hospital, Boston, MA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24265554

Citation

Foody, JoAnne M., et al. "Changes in LDL-C Levels and Goal Attainment Associated With Addition of Ezetimibe to Simvastatin, Atorvastatin, or Rosuvastatin Compared With Titrating Statin Monotherapy." Vascular Health and Risk Management, vol. 9, 2013, pp. 719-27.
Foody JM, Toth PP, Tomassini JE, et al. Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy. Vasc Health Risk Manag. 2013;9:719-27.
Foody, J. M., Toth, P. P., Tomassini, J. E., Sajjan, S., Ramey, D. R., Neff, D., Tershakovec, A. M., Hu, H., & Tunceli, K. (2013). Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy. Vascular Health and Risk Management, 9, 719-27. https://doi.org/10.2147/VHRM.S49840
Foody JM, et al. Changes in LDL-C Levels and Goal Attainment Associated With Addition of Ezetimibe to Simvastatin, Atorvastatin, or Rosuvastatin Compared With Titrating Statin Monotherapy. Vasc Health Risk Manag. 2013;9:719-27. PubMed PMID: 24265554.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy. AU - Foody,JoAnne M, AU - Toth,Peter P, AU - Tomassini,Joanne E, AU - Sajjan,Shiva, AU - Ramey,Dena R, AU - Neff,David, AU - Tershakovec,Andrew M, AU - Hu,Henry, AU - Tunceli,Kaan, Y1 - 2013/11/15/ PY - 2013/11/23/entrez PY - 2013/11/23/pubmed PY - 2014/6/18/medline KW - atorvastatin KW - ezetimibe KW - low-density lipoprotein cholesterol goal KW - rosuvastatin SP - 719 EP - 27 JF - Vascular health and risk management JO - Vasc Health Risk Manag VL - 9 N2 - BACKGROUND: Many high-risk coronary heart disease (CHD) patients on statin monotherapy do not achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals, and combination lipid-lowering therapy may be considered for these individuals. The effect of adding ezetimibe to simvastatin, atorvastatin, or rosuvastatin therapy versus titrating these statins on LDL-C changes and goal attainment in CHD or CHD risk-equivalent patients was assessed in a large, managed-care database in the US. METHODS: Eligible patients (n=17,830), initially on statin monotherapy who were ≥18 years with baseline and follow-up LDL-C values, no concomitant use of other lipid-lowering therapy, and on lipid-lowering therapy for ≥42 days, were identified between November 1, 2002 and September 30, 2009. The percent change from baseline in LDL-C levels and the odds ratios for attainment of LDL-C<1.8 and <2.6 mmol/L (70 and 100 mg/dL) were estimated using an analysis of covariance and logistic regression, respectively, adjusted for various baseline factors. RESULTS: LDL-C reductions from baseline and goal attainment improved substantially in patients treated with ezetimibe added onto simvastatin, atorvastatin, or rosuvastatin therapy (n=2,312) versus those (n=13,053) who titrated these statins. In multivariable models, percent change from baseline in LDL-C was -13.1% to -14.8% greater for those who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus those who titrated. The odds of attaining LDL-C<1.8 and <2.6 mmol/L (70 and 100 mg/dL) increased by 2.6-3.2-fold and 2.5-3.1-fold, respectively, in patients who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus titrating statins. CONCLUSION: CHD/CHD risk-equivalent patients in a large US managed-care database, who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin, had greater LDL-C reductions and goal attainment than those who uptitrated these statin therapies. Our study suggests that high-risk CHD patients in need of more intensive LDL-C lowering therapy may benefit by adding ezetimibe onto statin therapy. SN - 1178-2048 UR - https://www.unboundmedicine.com/medline/citation/24265554/Changes_in_LDL_C_levels_and_goal_attainment_associated_with_addition_of_ezetimibe_to_simvastatin_atorvastatin_or_rosuvastatin_compared_with_titrating_statin_monotherapy_ L2 - https://dx.doi.org/10.2147/VHRM.S49840 DB - PRIME DP - Unbound Medicine ER -