Abstract 15400: The Effects of High-Dose Statin Compared to the Combination of Low-dose Statin and Ezetimibe on Postprandial Lipids and Endothelial Function in Patients with Metabolic Syndrome
Lowering LDL-cholesterol (LDL-C) with statins reduces cardiovascular risk and mortality in both high- and low-risk patients. Low-dose statin therapy in combination with ezetimibe, an inhibitor of intestinal cholesterol absorption, lowers plasma LDL-C levels to a similar degree as high-dose statin therapy. It is unclear whether similar LDL-C lowering with combination therapy is as beneficial for arterial endothelial function as high-dose statin therapy. A pilot study raised the possibility that combination therapy may have an additional therapeutic advantage in protecting the endothelium in the postprandial state. In this multicenter, double blind, crossover trial, 100 abdominally obese patients with the metabolic syndrome were randomized to 6 wks treatment with simvastatin (Simva) 80mg or ezetimibe/simvastatin (Eze/Simva)10/10mg (Clinicaltrials.gov NCT00817843). Flow Mediated Dilation (FMD), Peripheral Arterial Tonometry (EndoPAT) and plasma lipids were measured fasting and after an oral lipid load at baseline and after both treatments. Fasting LDL-C levels were 69.5 mg/dl after treatment with Simva 80mg and 69.9 mg/dl after Eze/Simva 10/10mg. Plasma lipids were similar at 4 hrs after an oral lipid load and following both treatments. Fasting endothelial function was similar with both treatments when assessed by FMD (p=0.777) and EndoPAT (p=0.304) (table). The changes after an oral fatload for both treatments by FMD and EndoPAT were also not significantly different (FMD, p=0.766; EndoPAT, p=0.712, table). In conclusion, treatment with Simva 80 mg or Eze/Simva 10/10mg in patients with the metabolic syndrome was associated with similar effects on both fasting and postprandial endothelial function while attaining similar lipid levels. These findings suggest that endothelial function with high-dose statin or low-dose statin and ezetimibe combination therapy is related to the degree of lipid lowering in obese patients with metabolic syndrome.
- © 2011 by American Heart Association, Inc.