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Changes in LDL-C levels and goal attainment associated with addition of ezetimibe to simvastatin, atorvastatin, or rosuvastatin compared with titrating statin monotherapy

Authors Foody JM, Toth PP, Tomassini JE, Sajjan S, Ramey DR, Neff D, Tershakovec AM, Hu H, Tunceli K

Received 13 June 2013

Accepted for publication 12 August 2013

Published 15 November 2013 Volume 2013:9 Pages 719—727


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

JoAnne M Foody,1 Peter P Toth,2 Joanne E Tomassini,3 Shiva Sajjan,3 Dena R Ramey,3 David Neff,3 Andrew M Tershakovec,3 Henry Hu,3 Kaan Tunceli3

1Brigham and Women's Hospital, Boston, MA, 2CGH Medical Center, Sterling, IL, and University of Illinois College of Medicine, Peoria, IL, 3Merck & Co., Inc., Whitehouse Station, NJ, USA

Background: Many high-risk coronary heart disease (CHD) patients on statin monotherapy do not achieve guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals, and combination lipid-lowering therapy may be considered for these individuals. The effect of adding ezetimibe to simvastatin, atorvastatin, or rosuvastatin therapy versus titrating these statins on LDL-C changes and goal attainment in CHD or CHD risk-equivalent patients was assessed in a large, managed-care database in the US.
Methods: Eligible patients (n = 17,830), initially on statin monotherapy who were ≥18 years with baseline and follow-up LDL-C values, no concomitant use of other lipid-lowering therapy, and on lipid-lowering therapy for ≥42 days, were identified between November 1, 2002 and September 30, 2009. The percent change from baseline in LDL-C levels and the odds ratios for attainment of LDL-C <1.8 and <2.6 mmol/L (70 and 100 mg/dL) were estimated using an analysis of covariance and logistic regression, respectively, adjusted for various baseline factors.
Results: LDL-C reductions from baseline and goal attainment improved substantially in patients treated with ezetimibe added onto simvastatin, atorvastatin, or rosuvastatin therapy (n = 2,312) versus those (n = 13,053) who titrated these statins. In multivariable models, percent change from baseline in LDL-C was -13.1% to -14.8% greater for those who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus those who titrated. The odds of attaining LDL-C <1.8 and <2.6 mmol/L (70 and 100 mg/dL) increased by 2.6–3.2-fold and 2.5–3.1-fold, respectively, in patients who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin versus titrating statins.
Conclusion: CHD/CHD risk-equivalent patients in a large US managed-care database, who added ezetimibe onto simvastatin, atorvastatin, or rosuvastatin, had greater LDL-C reductions and goal attainment than those who uptitrated these statin therapies. Our study suggests that high-risk CHD patients in need of more intensive LDL-C lowering therapy may benefit by adding ezetimibe onto statin therapy.

Keywords: low-density lipoprotein cholesterol goal, ezetimibe, atorvastatin, rosuvastatin

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