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Addition of Ezetimibe Helps More Elderly Achieve LDL Cholesterol Goal Than Uptitration of Atorvastatin: Presented at CCC

EDMONTON, Alberta -- October 29, 2009 -- Adding a 10-mg dose of ezetimibe to an atorvastatin regime is more effective for bringing elderly patients to lipid treatment goals than doubling or even quadrupling the starting dose of atorvastatin, according to a study presented here at the 2009 Canadian Cardiovascular Congress (CCC).

The advantage was not only seen for low-density lipoprotein (LDL) but also for targets defined for apolipoprotein B (apoB) and total cholesterol (TC).

The relative advantage of adding ezetimibe is clinically important because "the more you get to the targets, the less patients have events. And the lower the dose of the statin, the better it is tolerated, especially in the older high-risk patients who were the subjects of this study," reported Christian Constance, MD, University of Montreal, Montreal, Quebec, at a presentation on October 27.

The study randomised 2,055 men and women aged 65 years or older who would be at a high risk of coronary events if they were not at goals on current therapy. These goals were defined as LDL <2.0 mmol/L, TC <4.0 mmol/L, a TC to high-density-lipoprotein (HDL) ratio of <4.0, apoB <0.85 g/L, and HDL of <1.0 mmol/L. All patients were initiated to atorvastatin 10 mg over a 6-week stabilisation phase before being randomised to receive ezetimibe 10 mg or to an initial dose of atorvastatin 20 mg for 6 weeks followed by atorvastatin 40 mg for another 6 weeks.

After 6 weeks, the proportion of patients at the LDL goal of <2.0 mmol/L was twice as great among those randomised to the combination therapy relative to those on atorvastatin 20 mg (62.3% vs 31.1%). Even when the monotherapy dose was increased to 40 mg, ezetimibe 10 mg plus atorvastatin 10 mg permitted a higher proportion of patients to reach the LDL goal (60.5% vs 49.7%).

When compared at 12 weeks, the combination also placed a significantly higher proportion of patients at the apoB goal (52.8% vs 46%) and the TC goal (55.2% vs 45.8%). The proportion of patients at the goal for the TC:HDL ratio was high in both groups (89.1% vs 87.6%).

Dr. Constance called lipid lowering a "numbers game" -- suggesting that any strategy that provides the best avenue to lipid goals, especially the LDL target, should be the treatment of choice.

The CCC is co-hosted by the Canadian Cardiovascular Society and the Heart and Stroke Foundation of Canada.

[Presentation title: Better Efficacy of Atorvastatin With Ezetimibe vs Uptitration of Atorvastatin in the Elderly: 2006 Canadian and 2007 European Guideline Target Attainment. Abstract 608]

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