Effect of ezetimibe/simvastatin vs atorvastatin on lowering levels of LDL-C
and non-HDL-C, ApoB, and hs-CRP in patients with type 2 diabetes
摘要：除了LDL-C，非高密度脂蛋白、载体蛋白B和CRP均为糖尿病患者发生心血管疾病的预测因子。该研究针对同时患有高胆固醇血症的2型糖尿病患者，证实依折麦布和辛伐他汀联合用药可同时降低LDL-C、非高密度脂蛋白、载体蛋白B和CRP。在评估和治疗有心血管疾病风险的患者上，这些因素有指导作用。
BACKGROUND: In addition to low-density lipoprotein cholesterol (LDL-C), non–high-density lipoprotein cholesterol (non–HDL-C), apolipoprotein B (ApoB), and high-sensitivity C-reactive protein (hs-CRP)are considered predictive for cardiovascular disease in type 2 diabetes mellitus (T2DM) patients.
OBJECTIVE: To assess the proportion of T2DM patients with hypercholesterolemia who attained the optional target level of LDL-C (<70 mg/dL) and additionally non–HDL-C (<100 mg/dL), ApoB (<90mg/dL), and hs-CRP (<2 mg/L), following treatment with ezetimibe/simvastatin (E/S) vs atorvastatin (A).
METHODS: This post-hoc analysis of a multicenter, randomized, double-blind, 6-week parallel study assessed the proportion of T2DM patients who attained specified LDL-C levels and non–HDL-C,ApoB, and hs-CRP with usual, recommended starting doses of E/S (10/20 mg) vs A (10 or 20 mg) and next highest doses of E/S (10/40 mg) vs A (40 mg) by logistic regression. Baseline triglyceride and hs-CRP effects were also evaluated.
RESULTS: Significantly higher percentages of patients treated with E/S compared to A achieved individual and concurrent target levels of LDL-C (<70 mg/dL), non–HDL-C (<100 mg/dL), and ApoB(<90 mg/dL) at all dose comparisons (P<0.05 to P<0.001). Baseline triglyceride levels had no effect on reaching LDL-C levels. Attainment of non–HDL-C (100 mg/dL), and ApoB (<90 mg/dL) was lower at triglycerides<200 mg/dL than 200 mg/dL. Achievement of hs-CRP level (<2 mg/L) was comparable for both treatments. Significantly more patients attained both LDL-C ( <70 mg/dL) and hs-CRP (<2 mg/L) at all E/S doses compared to A (P<0.05 to P<0.001), regardless of baseline CRP levels.
CONCLUSION: E/S provides a therapeutic option to T2DM patients for lowering not only LDL-C,but also non–HDL-C, ApoB, and hs-CRP. These factors may help guide assessment and treatment of cardiovascular disease risk in these patients.
