Lipid Research Laboratory, Emory University School of Medicine, Atlanta, GA.
J Am Heart Assoc. 2013 Aug 7;2(4):e000037. doi: 10.1161/JAHA.113.000037.
Combination therapy with ezetimibe/simvastatin (E/S) and extended-release niacin (N) has been reported to be safe and efficacious in concomitantly reducing low-density lipoprotein cholesterol and increasing high-density lipoprotein cholesterol in hyperlipidemic patients at high risk for atherosclerotic cardiovascular events. This analysis evaluated the effect of E/S coadministered with N on low-density lipoprotein particle number (LDL-P) and high-density lipoprotein particle number (HDL-P) as assessed by nuclear magnetic resonance (NMR) spectroscopy in patients with type IIa or IIb hyperlipidemia.
This was an analysis of a previously reported 24-week randomized, double-blind study in type IIa/IIb hyperlipidemic patients randomized to treatment with E/S (10/20 mg/day)+N (titrated to 2 g/day) or N (titrated to 2 g/day) or E/S (10/20 mg/day). Samples from a subset of patients (577 of 1220) were available for post hoc analysis of LDL-P and HDL-P by NMR spectroscopy. Increases in HDL-P (+16.2%) and decreases in LDL-P (-47.7%) were significantly greater with E/S+N compared with N (+9.8% for HDL-P and -21.5% for LDL-P) and E/S (+12.8% for HDL-P and -36.8% for LDL-P). In tertile analyses, those with the lowest baseline HDL-P had the greatest percent increase in HDL-P (N, 18.4/7.9/2.1; E/S, 19.3/12.2/5.3; and E/S+N, 26.9/13.8/6.9; all P<0.001). Individuals in the highest tertile of LDL-P had the greatest percent reduction in LDL-P (N, 18.3/23.1/24.6; E/S, 29.7/38.3/41.8; and E/S+N, 44.3/49.0/50.5; all P<0.001).
These results suggest that E/S+N improves lipoprotein particle number, consistent with its lipid-modifying benefits in type IIa or IIb hyperlipidemia patients and may exert the greatest effect in those with high LDL-P and low HDL-P at baseline.
依折麦布/辛伐他汀（E/S）联合烟酸缓释剂（N）的联合治疗在同时降低伴有 ASCVD 高危因素的血脂异常患者的 LDL-C 和升高 HDL-C 方面已被证实是安全且有效的。本分析通过 NMR 光谱评估了在 IIa 或 IIb 型高脂血症患者中，E/S 联合 N 对 LDL 颗粒数（LDL-P）和 HDL 颗粒数（HDL-P）的影响。
这是一项在 IIa/IIb 型高脂血症患者中进行的为期 24 周的随机、双盲研究的事后分析，这些患者被随机分配接受 E/S（10/20mg/天）+N（滴定至 2g/天）或 N（滴定至 2g/天）或 E/S（10/20mg/天）治疗。577/1220 例患者的亚组样本可通过 NMR 光谱进行 LDL-P 和 HDL-P 的事后分析。与 N（HDL-P 增加 9.8%，LDL-P 减少 21.5%）和 E/S（HDL-P 增加 12.8%，LDL-P 减少 36.8%）相比，E/S+N 可显著增加 HDL-P（+16.2%）和降低 LDL-P（-47.7%）。在三分位分析中，基线时 HDL-P 最低的患者的 HDL-P 增加百分比最大（N：18.4/7.9/2.1；E/S：19.3/12.2/5.3；E/S+N：26.9/13.8/6.9；均 P<0.001）。LDL-P 最高三分位的患者 LDL-P 降低百分比最大（N：18.3/23.1/24.6；E/S：29.7/38.3/41.8；E/S+N：44.3/49.0/50.5；均 P<0.001）。
这些结果表明，E/S+N 可改善脂蛋白颗粒数，这与其在 IIa 或 IIb 型高脂血症患者中的脂质调节作用一致，并且在基线时 LDL-P 较高且 HDL-P 较低的患者中可能发挥最大作用。
