Objective: Combination of ezetimibe (EZE) with a statin represents an attractive strategy for cholesterol-lowering treatment, as it inhibits the two main sources of cholesterol: absorption from the intestine (inhibited by EZE) and endogenous biosynthesis (inhibited by statins).
Research design and methods: This multicentre, double-blind, placebo-controlled study randomised a total of 148 men and women with primary hypercholesterolaemia and coronary heart disease (CHD) to receive treatment for 6 weeks with either EZE 10 mg + atorvastatin 10 mg (EZE + ATV; n = 72) or placebo/atorvastatin 10 mg (ATV; n = 76). The primary efficacy variable was the mean percentage change in low-density lipoprotein cholesterol (LDL-C) from baseline to study endpoint.
Results: At 6 weeks, EZE + ATV provided a significantly greater adjusted mean change from baseline in LDL-C compared with ATV monotherapy (-50.5% vs. -36.5%; p < 0.0001), equating to an additional 14.1% reduction (95% CI -17.90, -10.19) in LDL-C. A significantly higher proportion of patients on EZE + ATV achieved the new Joint British Societies (JBS 2) recommended LDL-C goal of < 2 mmol/L (62% vs. 12% with ATV alone; p < 0.0001) and the JBS 2 minimum treatment standard of < 3 mmol/L (93% vs. 79% with ATV alone). Patients receiving EZE + ATV were 12 times more likely to reach LDL-C targets (odds ratio 12.1; 95% CI 5.8, 25.1; p < 0.0001) compared with patients receiving ATV monotherapy. Clinical chemistry profiles and the incidence of adverse events were similar in both groups.
Conclusions: Adding EZE to ATV monotherapy represents an attractive and well-tolerated treatment option to bring patients at high risk of CHD to the aggressive LDL-C goals recommended by recent treatment guidelines.