Atorvastatin 10 mg plus ezetimibe versus titration to atorvastatin 40 mg: attainment of European and Canadian guideline lipid targets in high-risk subjects ≥65 years

Lipids in Health and Disease

Research

Ori Ben-Yehuda¹  Nanette K Wenger²  Christian Constance³  Franklin Zieve⁴  Jianxin Lin⁵  Andrew M Tershakovec⁵  Mary E Hanson⁵  Robert S Lowe⁵ 

[1] Clinical Trial Center, Cardiovascular Research Foundation, New York, NY, USA;Emory University School of Medicine, Altanta, GA, USA;Hopital Maisonneuve-Rosemont Recherche Clinique/Polyclinique, 5415 Boulevard de l’Assomption, Suite 295, H1T 2 M4, Montreal, QC, Canada;McGuire VA Medical Center, Richmond, VA, USA;Merck & Co. Inc., Whitehouse Station, NJ, USA;

关键词: Ezetimibe;    Atorvastatin;    Hyperlipidemia;    Elderly;    Statin;    Combination therapy;   

DOI  :  10.1186/1476-511X-13-13

 received in 2013-09-20, accepted in 2013-12-11,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundFew clinical studies have focused on the efficacy of lipid-lowering therapies in patients ≥65 years.MethodsAfter stabilization on atorvastatin 10 mg, hypercholesterolemic subjects ≥65 years at high/very high risk for CHD and not at LDL-C <1.81 mmol/L (with atherosclerotic vascular disease [AVD]) or <2.59 mmol/L (without AVD) were randomized to ezetimibe 10 mg plus atorvastatin 10 mg or uptitration to atorvastatin 20 mg (6 weeks) followed by uptitration to 40 mg (additional 6 weeks). A post-hoc analysis compared between-group differences in percent attainment of individual and combined LDL-C, non-HDL-C and Apo B targets based on recommendations from 2012 European and Canadian Cardiovascular Society (CCS) guidelines for dyslipidemia treatment.ResultsAtorvastatin 10 mg plus ezetimibe produced significantly greater attainment of LDL-C, non-HDL-C, and Apo B individual and dual/triple targets vs. atorvastatin 20 mg for the entire cohort and very high-risk groups at 6 weeks. After 12 weeks, very high-risk subjects maintained significantly greater achievement of LDL-C <1.8 mmol/L (47% vs. 35%), non-HDL-C <2.6 mmol/L (63% vs. 53%) and Apo B <0.8 g/L (47% vs. 38%) single targets and dual/triple targets with atorvastatin 10 mg plus ezetimibe vs. atorvastatin 40 mg, while attainment of European target for high-risk subjects was generally similar for both treatments. Achievement of Canadian targets was significantly greater with combination therapy vs. atorvastatin 20 mg (6 weeks) or atorvastatin 40 mg (12 weeks).ConclusionsAtorvastatin 10 mg plus ezetimibe provided more effective treatment than uptitration to atorvastatin 20/40 mg for attainment of most European and Canadian guideline-recommended lipid targets in older at-risk patients.Trial registrationClinicalTrials.gov identifierNCT00418834.

【 授权许可】

CC BY   
© Constance et al.; licensee BioMed Central Ltd. 2014