Abstract 15244: Measuring the Baseline Cholesterol Absorption and Synthesis Marker Can Predict the LDL-C Lowering Response to Ezetimibe-Statin Combination Therapy in Patients with Coronary Artery Disease : A Multi-Center Prospective Randomized Trial
Background: The clinical significance of measuring baseline absorption and synthesis marker in lipid-lowering therapy remains unclear. We assessed if baseline absorption and synthesis marker levels predict the low-density lipoprotein cholesterol (LDL-C) lowering response to ezetimibe-statin combination therapy in patients with coronary artery disease (CAD).
Methods: We performed a multi-center, prospective, randomized trial with 161 CAD patients who could not reach LDL-C level <100mg/dl despite treatment with 10mg atorvastatin or 2.5mg rosuvastatin (initial dose in Japan). Patients were randomly assigned to receive 10mg ezetimibe in addition to their ongoing statin (ES: n=90) or a double dose of the statin (DS: n=71) for 12 weeks. We measured the cholesterol absorption marker (Campesterol), the synthesis marker (Lathosterol) and the lipid profile at the baseline and after 12 weeks.
Results: There were no significant differences in baseline patient' characteristics (lipid profile, cholesterol absorption and synthesis marker levels) between the 2 groups. ES treatment led to a significantly greater reduction in LDL-C compared to DS treatment (−30+/−15.7 vs −19.1+/−13.9mg/dl, p<0.01). Then we divided them into 4 groups by the median level of baseline cholesterol absorption and synthesis marker (figure). ES' reduction in LDL-C was greater than DS' in Groups A, B and C (p<0.05), but there was no significant difference in the reduction between 2 groups in Group D. ES' reduction in LDL-C was significantly greater in higher absorption group (Group A, B) than in lower absorption group (Group C, D) (p<0.01), but DS' reduction was similar in all 4 groups.
Conclusions: The LDL-C lowering effect of ezetimibe-statin combination therapy was greater in patients with a higher baseline absorption marker. Measuring cholesterol absorption and synthesis marker was useful in predicting the LDL-C lowering response to ezetimibe-statin combination therapy in CAD patients .
- © 2010 by American Heart Association, Inc.