Effect of combination of ezetimibe and a statin on coronary plaque regression in patients with acute coronary syndrome

• Published in: IJC metabolic & endocrine 2014-06, Vol.3, p.8-13
• Main Authors: Nakajima, Naohisa, Miyauchi, Katsumi, Yokoyama, Takayuki, Ogita, Manabu, Miyazaki, Tadashi, Tamura, Hiroshi, Nishino, Akihisa, Yokoyama, Ken, Okazaki, Sinya, Kurata, Takeshi, Suwa, Satoru, Daida, Hiroyuki
• Format: Article
• Language: English
• Subjects: ACS; Coronary plaque; Diabetes; Endocrinology & Metabolism; IVUS; LDL-C
• ISSN: 2214-7624; 2214-7624
• DOI: 10.1016/j.ijcme.2014.03.001

Abstract Background Many trials have shown that statins can reduce plaque volume (PV) associated with the degree of LDL-C reduction. The goal of this study is to determine whether the combination of ezetimibe and a statin produces greater reductions in coronary plaque volume compared to statin monotherapy in patients with acute coronary syndrome (ACS). Methods Prospective serial intravascular ultrasound (IVUS) of non-culprit lesions of the target vessel was performed in 95 patients with ACS. Of these, 50 patients were administered combination of atorvastatin 20 mg/day and ezetimibe 10 mg/day. 45 subjects treated by atorvastatin 20 mg/day alone were the control group. At the beginning and 24 weeks after PCI, quantitative PV was accessed by IVUS. The primary end point was the percentage change in non-culprit coronary PV. Results LDL-C was significantly decreased by 49.8% in the ezetimibe/atorvastatin group compared with 34.6% in the atorvastatin group. Significant regression of plaque volume was observed from baseline to follow-up in both groups. The percentage changes in PV were greater in the ezetimibe/atorvastatin group than in the atorvastatin alone group (12.5% versus 7.6%, p = 0.06), but statistically not significant. In 34 diabetic patients, regression of PV was significantly greater in the ezetimibe/atorvastatin group than in the statin alone group (13.9% versus 5.1%, p = 0.04) and % change of PV significantly correlated with LDL-C reduction. Conclusions Additional LDL-C reduction with combination therapy tended to reduce more plaque regression compared to a statin alone in patients with ACS. In diabetic patients, further reduction of LDL-C was associated with a significantly greater reduction in PV.