Abstract 13048: The Impact of Statin-Ezetimibe Combination Therapy in Patients With Decreased Cholesterol Absorption Ability
Introduction: Ezetimibe (EZE) is a cholesterol absorption inhibitor and its clinical benefit, as combined with statin for pts with coronary artery disease (CAD), was shown by IMPROVE-IT trial. Campesterol (camp) is the cholesterol absorption marker and the benefit of EZE/statin combination therapy for pts with low camp (LC) value, in whom EZE appears to ineffective, is not clearly understood. The PRECISE-IVUS (Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile.
Hypothesis: In this study, we investigated the effect of EZE for pts with the LC value.
Methods: 246 pts undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination (EA) group or atorva alone (A) group. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients.
Results: There were significantly positive correlation between baseline LDL-C level and baseline camp value (R=0.399, p<0.01), but no significant difference between baseline camp value and the presence of prior statin use. Baseline LDL-C level was significantly lower in LC groups (LC group vs. high camp group; 100.2±25.5mg/dL vs. 116.8±23.5mg/dL, respectively, p<0.0001). In the LC group, the delta LDL-C ratio (follow up LDL-C - baseline LDL-C / baseline LDL-C) was significantly lower in EA group compared with A group (-37.2±16.2% vs. -23.4±25.1%, p=0,009) and EA group showed significantly greater reduction in delta percent atheroma volume, compared with A group (-2.2 [-4.1 to -0.1]% vs. -0.3 [-1.6 to 1.1]%, p=0.04).
Conclusions: Even in pts with CAD and LC value, statin-EZE combined therapy showed significantly decreased LDL-C and regressed coronary plaque burden. Even if the cholesterol absorption ability is declined, EZE-statin combined therapy might be the promising option for pts with CAD.
Author Disclosures: K. Yamanaga: None. K. Tsujita: Research Grant; Modest; Abbott Vascular, Boston Scientific, Terumo Corp., Volcano Corp.. Speakers Bureau; Modest; Daiichi Sankyo Co., Ltd., Bristol-Myers Squibb Company, MSD K.K., Pfizer Japan Inc, Sanofi K.K., Takeda Pharmaceutical Co., Novartis Pharma K.K.. S. Sugiyama: None. H. Sumida: None. H. Shimomura: None. T. Yamashita: None. N. Komura: None. K. Sakamoto: None. H. Oka: None. K. Nakao: None. S. Nakamura: None. M. Ishihara: Speakers Bureau; Modest; MSD. K. Matsui: None. N. Skaino: None. N. Nakamura: None. N. Yamamoto: None. S. Koide: None. T. Matsumura: None. K. Fujimoto: None. R. Tsunoda: None. Y. Morikami: None. K. Matsuyama: None. S. Oshima: None. K. Kaikita: None. S. Hokimoto: None. H. Ogawa: Other Research Support; Modest; Astellas Pharma Inc, Bristol-Myers Squibb Company, Chugai Pharmaceutical Co, Ltd., Dainippon Sumitomo Pharma Co., Ltd., MSD K.K., Mochida Pharmaceutical Co., Ltd., Ono Pharmaceutical Co., Ltd., Otsuka, Pfizer Japan Inc, Takeda Pharmaceutical Co., Ltd.. Other Research Support; Significant; Bayer, Daiichi Sankyo Co., Ltd., Novartis Pharma K.K., Sanofi K.K.. Honoraria; Modest; AstraZeneca K.K., Boehringer Ingelheim Japan, Bristol-Myers Squibb Company, Mitsubishi Tanabe Pharma, Pfizer Japan Inc, Sanofi K.K., Teijin Pharma Co., Ltd. Honoraria; Significant; Bayer Yakuhin, Ltd., Daiichi Sankyo Co., Ltd., MSD K.K., Takeda Pharmaceutical Co., Ltd..
- © 2015 by American Heart Association, Inc.