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Timing of Ezetimibe Relative to Statin Affects Plaque Regression

Ezetimibe started along with initial statin therapy improves plaque, but not when added on later

THURSDAY, June 2 (HealthDay News) -- Ezetimibe may be beneficial for regressing atherosclerosis in statin-naive patients with peripheral artery disease (PAD), but when added to existing statin therapy, it may lead to atherosclerosis progression, according to a study published online May 16 in Atherosclerosis.

Amy M. West, M.D., from the University of Virginia in Charlottesville, and colleagues investigated whether reducing low-density lipoprotein cholesterol (LDL-C) levels by adding ezetimibe to statin therapy would regress atherosclerosis in 67 patients with PAD. A total of 34 statin-naive patients were randomized to treatment with 40 mg simvastatin or 40 mg simvastatin plus 10 mg of ezetimibe. A group of 33 patients, who were already treated with statins and had LDL-C above 80 mg/dL, had an open-label 10 mg ezetimibe added. Atherosclerotic plaque volumes were measured by magnetic resonance imaging in the superficial femoral artery at baseline and then annually for two years.

The investigators found that LDL-C was significantly lower in patients treated with simvastatin plus ezetimibe at the first year compared to patients treated with simvastatin alone, but levels were similar at year two. No progression in plaque volume was seen in either group during the two-year study period. In contrast, in patients who had ezetimibe added to their previous statin therapy, there was a significant plaque progression despite a 22 percent decrease in LDL-C.

"In patients with peripheral arterial atherosclerosis, initiation of a statin with or without ezetimibe leads to a halting of plaque progression. In contrast, patients already on a statin who were treated with ezetimibe demonstrated plaque progression despite pronounced further LDL-C lowering," the authors write.

Several authors disclosed financial ties with Siemens Medical Solutions. Study drugs were supplied by Merck Schering Plough.

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