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Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia.

Publication ,  Journal Article
Tomassini, JE; Mazzone, T; Goldberg, RB; Guyton, JR; Weinstock, RS; Polis, A; Jensen, E; Tershakovec, AM
Published in: Diabetes Obes Metab
September 2009

AIM: To evaluate the effects of the usual starting and next higher doses of ezetimibe/simvastatin and atorvastatin on the cholesterol content of lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia. METHODS: This post hoc analysis compared the effects of treatment with ezetimibe/simvastatin 10/20 mg vs. atorvastatin 10 and 20 mg/day and ezetimibe/simvastatin 10/40 mg/day vs. atorvastatin 40 mg/day on the cholesterol content of lipoprotein subclasses in the modified intent-to-treat (mITT) population (n = 1013) and in subgroups of patients with triglyceride (TG) levels <200 mg/dl (n = 600) and >or=200 mg/dl (2.6 mmol/l) (n = 413). RESULTS: Ezetimibe/simvastatin significantly reduced low-density lipoprotein cholesterol (LDL-C) subclasses LDL(1)-C, LDL(2)-C and LDL(3)-C; real LDL-C (LDL-C(r)); intermediate-density lipoprotein cholesterol (IDL-C), IDL(1)-C, IDL(2)-C; very low-density lipoprotein cholesterol (VLDL-C), VLDL(3)-C; and remnant-like lipoprotein cholesterol (RLP-C) from baseline more than atorvastatin at all dose comparisons (p < 0.01) in the mITT population. Significant improvements were also observed in high-density lipoprotein cholesterol (HDL-C) subclass HDL(3)-C at the ezetimibe/simvastatin 10/20 mg vs. atorvastatin 20 mg and highest dose comparisons (p < 0.001) and in VLDL(1 + 2)-C at the lowest and highest dose comparisons (p < 0.001). Changes in LDL(4)-C and LDL-C subclass patterns (A, B and I) were comparable for both treatments. Generally, similar results were observed for patients with TG levels <200 and >or=200 mg/dl (2.3 mmol). For both treatments, notable differences between TG subgroups were that patients with elevated TGs had smaller reductions in LDL(2)-C, slightly smaller decreases in all IDL subclasses and greater decreases in all VLDL-C subclasses than those with lower TG levels. Frequency of pattern B was also reduced more in patients with higher TGs for both treatments. CONCLUSIONS: Ezetimibe/simvastatin reduced the cholesterol content of most lipoprotein subclasses from baseline with generally similar efficacy in patients with low and high TGs. Despite the different mechanism of action of ezetimibe, the response to ezetimibe/simvastatin and atorvastatin treatment related to these lipoprotein subclasses was generally consistent with the overall effects of these therapies on the major lipid/lipoprotein classes. The clinical significance of these results awaits further study.

Duke Scholars

Published In

Diabetes Obes Metab

DOI

EISSN

1463-1326

Publication Date

September 2009

Volume

11

Issue

9

Start / End Page

855 / 864

Location

England

Related Subject Headings

  • Young Adult
  • Simvastatin
  • Pyrroles
  • Middle Aged
  • Male
  • Hypercholesterolemia
  • Humans
  • Heptanoic Acids
  • Female
  • Ezetimibe
 

Citation

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Tomassini, J. E., Mazzone, T., Goldberg, R. B., Guyton, J. R., Weinstock, R. S., Polis, A., … Tershakovec, A. M. (2009). Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia. Diabetes Obes Metab, 11(9), 855–864. https://doi.org/10.1111/j.1463-1326.2009.01061.x
Tomassini, J. E., T. Mazzone, R. B. Goldberg, J. R. Guyton, R. S. Weinstock, A. Polis, E. Jensen, and A. M. Tershakovec. “Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia.Diabetes Obes Metab 11, no. 9 (September 2009): 855–64. https://doi.org/10.1111/j.1463-1326.2009.01061.x.
Tomassini JE, Mazzone T, Goldberg RB, Guyton JR, Weinstock RS, Polis A, et al. Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia. Diabetes Obes Metab. 2009 Sep;11(9):855–64.
Tomassini, J. E., et al. “Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia.Diabetes Obes Metab, vol. 11, no. 9, Sept. 2009, pp. 855–64. Pubmed, doi:10.1111/j.1463-1326.2009.01061.x.
Tomassini JE, Mazzone T, Goldberg RB, Guyton JR, Weinstock RS, Polis A, Jensen E, Tershakovec AM. Effect of ezetimibe/simvastatin compared with atorvastatin on lipoprotein subclasses in patients with type 2 diabetes and hypercholesterolaemia. Diabetes Obes Metab. 2009 Sep;11(9):855–864.
Journal cover image

Published In

Diabetes Obes Metab

DOI

EISSN

1463-1326

Publication Date

September 2009

Volume

11

Issue

9

Start / End Page

855 / 864

Location

England

Related Subject Headings

  • Young Adult
  • Simvastatin
  • Pyrroles
  • Middle Aged
  • Male
  • Hypercholesterolemia
  • Humans
  • Heptanoic Acids
  • Female
  • Ezetimibe