Meyers Charles D, Moon Yong S K, Ghanem Hoda, Wong Nathan D
Atherosclerosis Research Center, Veterans Affairs Long Beach Healthcare System, Long Beach, CA 90822-5201, USA.
Ann Pharmacother. 2006 May;40(5):818-23. doi: 10.1345/aph.1G639. Epub 2006 Apr 25.
Ezetimibe as monotherapy or in combination with statins effectively lowers low-density lipoprotein cholesterol (LDL-C). However, there are few reports of ezetimibe's effect when added to ongoing non-statin lipid-lowering drugs or combination lipid-lowering therapy.
To evaluate the impact of preexisting lipid therapy on LDL-C response to ezetimibe.
We performed a retrospective review of all patients started on ezetimibe therapy at the Veterans Affairs Long Beach Healthcare System between March 1, 2003, and March 1, 2005. We calculated the ezetimibe-induced percent change in LDL-C in patients without concomitant changes in other lipid-lowering medications. We then stratified the population according to the type and number of preexisting lipid therapies and compared the LDL-C-lowering efficacy of ezetimibe among these groups.
Overall, ezetimibe was associated with a 23.0% reduction in LDL-C. Patients with preexisting statin monotherapy had significantly greater LDL-C reduction with ezetimibe than did those with preexisting non-statin drugs (-26.1% vs -9.3%; p = 0.0138). In patients with no preexisting lipid therapy (n = 58), monotherapy (n = 115), double therapy (n = 36), or triple therapy (n = 9), ezetimibe decreased LDL-C by 17.3%, 21.4%, 33.5%, and 38.1%, respectively. This stepwise trend in increased ezetimibe efficacy was statistically significant, even with adjustments for baseline LDL-C.
Ezetimibe's LDL-C-lowering effects are most pronounced when added to preexisting combination lipid therapy. It appears to be more effective when added to statin therapy compared with other lipid-lowering therapies.
依折麦布单药治疗或与他汀类药物联合使用可有效降低低密度脂蛋白胆固醇（LDL-C）。然而，关于依折麦布添加到正在使用的非他汀类降脂药物或联合降脂治疗中的效果的报道较少。
评估既往降脂治疗对依折麦布降低LDL-C反应的影响。
我们对2003年3月1日至2005年3月1日期间在退伍军人事务部长滩医疗系统开始接受依折麦布治疗的所有患者进行了回顾性研究。我们计算了在其他降脂药物无伴随变化的患者中依折麦布引起的LDL-C百分比变化。然后根据既往降脂治疗的类型和数量对人群进行分层，并比较这些组中依折麦布降低LDL-C的疗效。
总体而言，依折麦布使LDL-C降低了23.0%。既往接受他汀类单药治疗的患者使用依折麦布后LDL-C降低幅度显著大于既往使用非他汀类药物的患者（-26.1%对-9.3%；p = 0.0138）。在既往未接受降脂治疗的患者（n = 58）、单药治疗患者（n = 115）、联合治疗患者（n = 36）或三联治疗患者（n = 9）中，依折麦布分别使LDL-C降低了17.3%、21.4%、33.5%和38.1%。即使对基线LDL-C进行了调整，依折麦布疗效增加的这种逐步趋势在统计学上仍具有显著性。
依折麦布添加到既往联合降脂治疗中时，其降低LDL-C的效果最为显著。与其他降脂治疗相比，添加到他汀类治疗中似乎更有效。
