New Lipid-Lowering Combo Proves Successful
Combining ezetimibe and atorvastatin, two lipid-lowering drugs with different mechanisms of action, resulted in significant “incremental” reductions of low-density lipoprotein and triglycerides and increases in high-density lipoprotein, according to a report in this week’s issue of the journal Circulation (Circulation. 2003;107:2409–2415).
In this study led by Christie Ballantyne, MD, Professor of Medicine at Baylor College of Medicine, 628 patients with baseline low-density lipoprotein levels of 145 to 250 mg/dL and triglycerides above 350 mg/dL were randomized to receive one of the following: 10 mg of ezetimibe or atorvastatin at 10, 20, 40, or 80 mg per day; a combination of 10 mg ezetimibe plus atorvastatin at 10, 20, 40, or 80 mg per day; or a placebo. Treatment continued for 12 weeks.
The researchers found that ezetimibe plus atorvastatin significantly lowered low-density lipoprotein cholesterol (LDL-C), triglycerides, and high-sensitivity C-reactive protein levels compared with atorvastatin alone. High-density lipoprotein cholesterol (HDL-C) levels increased significantly in patients who received the combination.
Administering ezetimibe with atorvastatin decreased LDL-C an additional 12%, triglycerides an additional 8%, and C-reactive protein an additional 10%. HDL-C increased 3% with the combination treatment.
The researchers concluded: “Ezetimibe plus atorvastatin was well tolerated, with a safety profile similar to atorvastatin alone and to placebo. When coadministered with atorvastatin, ezetimibe provided significant incremental reduction in LDL-C and triglycerides and increases in HDL-C. Coadministration of ezetimibe and atorvastatin offers a well-tolerated and highly efficacious new treatment option for patients with hypercholesterolemia.”
“In clinical practice, ezetimibe coadministered with a statin may enable more patients to achieve recommended target LDL-C levels by offering greater LDL-C lowering with fewer dose titrations as well as a well-tolerated alternative for patients in whom maximal dose statin monotherapy is inadequate,” they wrote.
More Hypertension Seen in Europe
Surveys of blood pressure in Germany, Finland, Sweden, England, Spain, Italy, Canada, and the United States found higher blood pressure in the European countries than in the United States in men and women aged 35 to 74 years, according to a report in this week’s Journal of the American Medical Association (JAMA. 2003:289:2363–2369).
The average blood pressure was 136/83 mm Hg in the European countries and 127/77 mg Hg in Canada and the United States, said the researchers, led by Katharina Woif-Maler, MD, and Richard S. Cooper, MD, both of the Department of Preventive Medicine and Epidemiology at Loyola University Stritch School of Medicine in Maywood, Ill.
The researchers pointed out that the pattern of higher rates of hypertension in Europe corresponds with death rates from stroke, the condition most commonly associated with uncontrolled hypertension. They note that several important questions about the data remain. For example, why has the difference in blood pressure measurements and the prevalence of hypertension in the European population not been better recognized? Why has there been no research into the underlying etiology?
They wrote, “In the United States, enormous attention has been focused on racial differences, particularly between blacks and whites, although these differences are only half as large as those between the United States and Europe. Genetic factors have been at the top of the agenda to explain black-white differentials, although African origin populations in contrasting social contexts also show wide variation in hypertension prevalence.”
“North American populations are predominantly of European ancestry, and genetics is not a plausible explanation of the finding reported herein. The only etiologic risk factor collected in a systematic way by our surveys was BMI [body mass index], which was weakly correlated with hypertension prevalence . . . . Data from the International Study of Electrolyte Excretion and Blood Pressure (INTERSALT) do not suggest large differences in intake in sodium or potassium between the US and European components of that study, although the samples were relatively small and not necessarily representative. In view of the recent evidence that intake of fruits and vegetables has a substantial impact on BP [blood pressure], difference in dietary composition is another important hypothesis to consider.”
They concluded: “Based on the evidence presented herein, Europe should be considered a high prevalence hypertension region. Our study provides no direct information on what the causal explanations might be but rather places this topic on the research agenda.”
Public Does Not Recognize “Mini-Stroke”
A phone survey of more than 10 000 people found that only 9% of them could define transient ischemic attack (TIA) or identify a symptom of the disorder, said researchers from the University of California at San Francisco in the May 13, 2003, issue of the journal Neurology (Neurology. 2003; 60:1429–1434).
The survey also found that 3.2% of those surveyed had symptoms of TIA but never saw a physician about them. Of those who had been diagnosed as having a TIA, 16% saw the physician more than a week after the symptoms happened.
“People think that because these symptoms go away quickly, they don’t need to worry about them,” said S. Claiborne Johnston, MD, PhD, of the University of California at San Francisco, in a released statement. “People who have a TIA are at high risk of having a stroke, particularly in the first few days after the TIA, and doctors can help them reduce the risk.”
The National Stroke Association sponsored the survey. A total of 10 112 people, chosen randomly, were surveyed. All were at least 18 years of age and all were speakers of English. More than 2% of those surveyed reported having been diagnosed with a TIA.