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Simvastatin Tops Ezetimibe for Endothelial Protection

Treatment with both a statin and ezetimibe offers most benefit for lymphocyte suppression

FRIDAY, June 24 (HealthDay News) -- Simvastatin is more effective than ezetimibe in treating patients with high cholesterol levels, but treatment with a combination is most beneficial, according to a study published online May 30 in the Journal of Internal Medicine.

Robert Krysiak, M.D., Ph.D., from the Medical University of Silesia in Katowice, Poland, and colleagues investigated the effects of ezetimibe and simvastatin alone or in combination on the secretory function of human lymphocytes, systemic inflammation, and endothelial function. A group of 170 ambulatory patients with elevated cholesterol levels was randomly assigned to, and completed 90 days of treatment with, 10 mg ezetimibe, 40 mg simvastatin, 10 mg ezetimibe plus 40 mg simvastatin, or a placebo. The main outcome measures were lymphocyte cytokine release and the plasma levels of high-sensitivity C-reactive protein (hsCRP) and intercellular adhesion molecule 1 (ICAM-1).

The investigators found that both drugs reduced lymphocyte release of tumor necrosis factor-α, interferon-γ, and interleukin-2 in a lipid-independent manner, but only simvastatin had a significant effect. This effect, together with a significant decrease in plasma levels of hsCRP and ICAM-1, was strongest for patients in the simvastatin and ezetimibe treatment group. No differences in the main outcome measures were seen between insulin-resistant and insulin-sensitive patients in the simvastatin group, but the effects of ezetimibe and the combination of ezetimibe and simvastatin were significantly greater in insulin-resistant patients.

"Simvastatin is superior to ezetimibe in producing lymphocyte-suppressing, systemic anti-inflammatory, and endothelial protective effects in patients with elevated cholesterol levels. Hypercholesterolemic patients with high cardiovascular risk may receive the greatest benefits from concomitant treatment with a statin and ezetimibe," the authors write.

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