By Marvin Ross
TORONTO -- October 29, 2008 -- Statin use and, in particular, the use of ezetimibe is vital in reaching a low-density lipoprotein (LDL) goal of 2 mmol/L or less in the majority of patients with coronary artery disease, researchers stated here at the Canadian Cardiovascular Congress (CCC).
Although statin use is a vital factor in reaching targets, combination therapy and especially the use of ezetimibe appears to be required in a sizable proportion of patients, noted Janek Senaratne, MD, Grey Nuns Hospital and University of Alberta, Edmonton, Alberta, speaking here on October 26.
Dr. Senaratne and his fellow investigators studied 360 consecutive patients with coronary artery disease (CAD) who were enrolled in a cardiac rehabilitation program. The subjects' mean age was 61.8 years and over 75% were male (78.1%). Other characteristics of the sample were as follows: diabetes 21.1%; hypertension 51.7%; smokers 31.9%; and mean body mass index of 29.6.
Subjects were taking atorvastatin (76.1%, mean dose 36.9 mg); simvastatin (12.2%, mean dose 32.0 mg); rosuvastatin (7.8%, mean dose 13.2 mg); pravastatin (1.1%, mean dose 35.0 mg); and gemfibrozil (0.6%, mean dose 1,200 mg). Only 2.2% were taking no medication.
Combination therapy was required in 101 patients (28.1%). The agents used were ezetimibe (22.2%), fibrates (4.4%), and niacin (1.4%).
Of the 360 patients, 307 (85.3%) were able to achieve an LDL of 2 mmol/L or less.
Baseline total cholesterol, LDL, high-density lipoprotein, and triglycerides were 5.73 +- 0.06; 3.71 +- 0.06; 1.11 +- 0.01; and 2.22 +- 0.09, respectively. At the end of the rehabilitation program, the measures were 3.25 +- 0.03; 1.65 +- 0.02; 0.99 +- 0.01; and 1.36 +- 0.04, respectively.
A univariate regression analysis found the following to be significant in achieving these levels: statin use, attending nutrition classes, and employment status (all with P < .001), as well as baseline cholesterol (P = .006); baseline LDL (P = .02); and time in rehabilitation (P = .04).
In a multivariate regression analysis, variables having significant independent influence were statin use (P < .001), employment status (P < .001), and attending nutrition classes (P = .009).
[Presentation title: Can the Currently Available Lipid Lowering Agents Achieve the LDL Targets They Have Established in Coronary Artery Disease. Abstract 056-002]
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