Article

The IMPROVE-IT trial showed that the clinical benefit of
statin/ezetimibe combination appeared to be pronounced in patients with prior
statin therapy. We hypothesized that the antiatherosclerotic effect of
atorvastatin/ezetimibe combination was pronounced in patients with statin
pretreatment. METHODS: In the prospective, randomized, controlled, multicenter
PRECISE-IVUS trial, 246 patients undergoing intravascular ultrasound-guided
percutaneous coronary intervention were randomized to atorvastatin/ezetimibe
combination or atorvastatin alone. The dosage of atorvastatin was uptitrated with
a treatment goal of lowering low-density lipoprotein cholesterol to below 70
mg/dl in both groups. Serial volumetric intravascular ultrasound was performed at
baseline and 9-12 month follow-up to quantify the coronary plaque response in 202
patients. We compared the intravascular ultrasound endpoints in all subjects,
stratified by the presence or absence of statin pretreatment. RESULTS: The
baseline low-density lipoprotein cholesterol level (100.7 +/- 23.1 mg/dl vs.
116.4 +/- 25.9 mg/dl, p < 0.001) and lathosterol (55 (38 to 87)) microg/100 mg
total cholesterol vs. 97 (57 to 149) microg/100 mg total cholesterol, p < 0.001)
was significantly lower, and campesterol/lathosterol ratio (3.9 (2.4 to 7.4) vs.
2.6 (1.5 to 4.1), p < 0.001) was significantly increased in patients with statin
pretreatment. Contrary to the patients without statin pretreatment (-1.3 (-3.1 to
-0.1)% vs. -0.9 (-2.3 to 0.9)%, p = 0.12), the atorvastatin/ezetimibe combination
showed a significantly stronger reduction in delta percent atheroma volume,
compared with atorvastatin alone, in patients with statin pretreatment (-1.8
(-3.6 to -0.3)% vs. -0.1 (-1.6 to 0.8)%, p = 0.002). CONCLUSION: Compensatory
increase in cholesterol absorption observed in statin-treated patients might
attenuate the inhibitory effects of statins on coronary plaque progression. A
low-dose statin/ezetimibe combination might be a promising option in
statin-hyporesponder.
CI - (c) The European Society of Cardiology 2016.

Langue : ANGLAIS