Efficacy and Safety of Combined Lipid-Lowering Therapy with Ezetemibe and Atorvastatin in Patients with Acute Myocardial Infarction

Ya.M. Lutay, O.I. Irkin, A.A. Stepura, D.A. Bely, A.N. Parkhomenko

Abstract


Statins reduce cholesterol levels, mainly due to the impact on its synthesis in the liver. But the rate and completeness of absorption of cholesterol in the intestine are also affect the lipid spectrum of blood. Ezetimibe is one of the first drugs that block this process. The objective of this work — to examine the safety and efficacy of low-dose combined lipid-lowering therapy compared with aggressive statin therapy in patients with acute myocardial infarction.
A total of 70 patients with acute myocardial infarction admitted to hospital within the first 24 hours (mean 5.2 ± 1.0 h) after symptoms onset. Patients were randomized into two groups: first one — 35 patients receiving low-dose combination of atorvastatin 10 mg and ezetimibe 10 mg (A10/E10), second one — 35 patients treated with atorvastatin 40 mg (A40) on the background of basic therapy.
Combined therapy was similar to atorvastatin monotherapy by lipid-lowering efficacy, but both regimens made it possible to achieve the recommended reduction of low-density lipoprotein cholesterol level less than 2.6 mmol/l only in approximately 75 % of patients, and less than 1.8 mmol/l — only in 1/3 of patients. More significant decrease in serum triglyceride level was noted in patients treated with combined therapy (35 % A10/E10 vs 19.5 % A40, respectively; p < 0.05). A10/E10 combination has anti-inflammatory effect similar to that of A40 and advantages over A40 monotherapy in the effect on the endothelium function. A10/E10 application was associated with a trend to endothelial function improvement already after 7 days of treatment, and after 90 days of treatment increase in brachial artery diameter in this group of patients was significantly higher than in atorvastatin monotherapy (12.19 ± 1.09 A10/E10 vs 9.25 ± 1.16 A40; p < 0.05). Groups did not differ in the incidence of major complications in hospital and early posthospital periods of the disease.


Keywords


acute myocardial infarction; lipid-lowering therapy; atorvastatin; ezetimibe; endothelial dysfunction

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DOI: https://doi.org/10.22141/2224-0586.3.58.2014.83238

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