Changes in lipoprotein particle number with ezetimibe/simvastatin coadministered
with extended-release niacin in hyperlipidemic patients.
Author(s): Le NA(1), Jin R, Tomassini JE, Tershakovec AM, Neff DR, Wilson PW.
Affiliation(s): Author information:
(1)Lipid Research Laboratory, Emory University School of Medicine, Atlanta, GA.
Publication date & source: 2013, J Am Heart Assoc. , 2(4):e000037
BACKGROUND: Combination therapy with ezetimibe/simvastatin (E/S) and
extended-release niacin (N) has been reported to be safe and efficacious in
concomitantly reducing low-density lipoprotein cholesterol and increasing
high-density lipoprotein cholesterol in hyperlipidemic patients at high risk for
atherosclerotic cardiovascular events. This analysis evaluated the effect of E/S
coadministered with N on low-density lipoprotein particle number (LDL-P) and
high-density lipoprotein particle number (HDL-P) as assessed by nuclear magnetic
resonance (NMR) spectroscopy in patients with type IIa or IIb hyperlipidemia.
METHODS AND RESULTS: This was an analysis of a previously reported 24-week
randomized, double-blind study in type IIa/IIb hyperlipidemic patients randomized
to treatment with E/S (10/20 mg/day)+N (titrated to 2 g/day) or N (titrated to 2
g/day) or E/S (10/20 mg/day). Samples from a subset of patients (577 of 1220)
were available for post hoc analysis of LDL-P and HDL-P by NMR spectroscopy.
Increases in HDL-P (+16.2%) and decreases in LDL-P (-47.7%) were significantly
greater with E/S+N compared with N (+9.8% for HDL-P and -21.5% for LDL-P) and E/S
(+12.8% for HDL-P and -36.8% for LDL-P). In tertile analyses, those with the
lowest baseline HDL-P had the greatest percent increase in HDL-P (N,
18.4/7.9/2.1; E/S, 19.3/12.2/5.3; and E/S+N, 26.9/13.8/6.9; all P<0.001).
Individuals in the highest tertile of LDL-P had the greatest percent reduction in
LDL-P (N, 18.3/23.1/24.6; E/S, 29.7/38.3/41.8; and E/S+N, 44.3/49.0/50.5; all
P<0.001).
CONCLUSIONS: These results suggest that E/S+N improves lipoprotein particle
number, consistent with its lipid-modifying benefits in type IIa or IIb
hyperlipidemia patients and may exert the greatest effect in those with high
LDL-P and low HDL-P at baseline.
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