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The effect of ezetimibe on peripheral arterial atherosclerosis depends upon statin use at baseline
Atherosclerosis, 09/08/2011
Clinical Article
West AM et al. – Statin initiation with or without ezetimibe in statin–naïve patients halts progression of peripheral atherosclerosis. When ezetimibe is added to patients previously on statins, peripheral atherosclerosis progressed. Thus, ezetimibe's effect on peripheral atherosclerosis may depend upon relative timing of statin therapy.
Methods- Atherosclerotic plaque volume was measured in the proximal 15–20cm of the SFA in 67 PAD patients (age 63±10, ABI 0.69±0.14) at baseline and annually×2.
- Statin–naïve patients (n=34) were randomized to simvastatin 40mg (S, n=16) or simvastatin 40mg+ezetimibe 10mg (S+E, n=18).
- Patients already on statins but with LDL–C >80mg/dl had open–label ezetimibe 10mg added (E, n=33).
- Repeated measures models estimated changes in plaque parameters over time and between–group differences.
- LDL–C was lower at year 1 in S+E (67±7mg/dl) than S (91±8mg/dl, p<0.05), but similar at year 2 (68±10mg/dl vs. 83±11mg/dl, respectively).
- Plaque volume did not change from baseline to year 2 in either S+E (11.5±1.4–10.5±1.3cm3, p=NS) or S (11.0±1.5–10.5±1.4cm3, p=NS).
- In E, plaque progressed from baseline to year 2 (10.0±0.8–10.8±0.9, p<0.01) despite a 22% decrease in LDL–C.
