Ezetimibe makes atorvastatin more efficient in lowering lipids in men and women age 65 and older
Adding ezetimibe to atorvastatin significantly boosted the attainment of lipid targets as specified by both Canadian and European guidelines in elderly patients aged 65 and older and the combination produced superior results than simply increasing the dose of atorvastatin alone, Dr. Christian Constance told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
"The population of people age 65 and older is growing but very few studies have looked at the efficacy of lipid-lowering drugs in this group of patients. We wanted to see whether adding ezetimibe to atorvastatin would be as effective as doubling or even quadrupling the dose of atorvastatin in this age group," said Dr. Constance, of the University of Montreal.
The study included 2,055 patients who were at high risk for coronary heart disease or who had been diagnosed with arterial vascular disease and who were not at the following cholesterol targets:
- Less than 2 mmol/L for low density lipoprotein cholesterol (LDL-C)
- Less than 4 mmol/L for total cholesterol (TC)
- TC to high density lipoprotein cholesterol (HDL) ratio less than 4
- Less than 0.85g/L for apolipoprotein B (ApoB)
- Less than 1.0 mg/L for high sensitivity-C-reactive protein (hs-CRP)
The patients were stabilized on atorvastatin 10 mg/day for six weeks and then were randomized to receive either ezetimibe 10 mg/day in addition to atorvastatin 10 mg/day for 12 weeks or to atorvastatin 20 mg/day for six weeks, followed by a quadrupling of atorvastatin to 40 mg/day for six weeks. Significantly more patients achieved their lipid targets with the ezetimibe plus atorvastatin combination compared with double or quadruple dose monotherapy with atorvastatin. For example, the percent of patients achieving their LDL-C targets on the ezetimibe/atorvastatin combination at 12 weeks was 60.5% compared with 49.7% for patients on the atorvastatin 20mg/40mg regimen [Odds ratio (95% CI)1.55 (1.21, 1.98)].
All treatments were well tolerated.