Effect of combination of ezetimibe and a statin on coronary plaque regression in patients with acute coronary syndrome
Open accessAbstract
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). 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. 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. 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.
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Controlling the LDL-C at a target level of < 70 mg/dL is useful for plaque regression in high-risk secondary prevention cases such as ACS or ACS complicated by DM.
“The results of ESTABLISH642), JAPAN-ACS643), the ZEUS study644), and PRECISE-IVUS645) have shown that in cases stratified into a high-risk category even in secondary prevention, such as ACS or ACS complicated by DM, controlling the LDL-C at a target level of < 70 mg/dL is useful for plaque regression.”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [642]
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References 23 · Cited by 37
Research works printed but not linked: 1
- Arai H, Hiro T, Kimura T, et al. More intensive lipid lowering is associated with regression of coronary atherosclerosis in diabetic patients with acute coronary syndrome. J Atheroscler Thromb 2010;17:1096-107.
- Authors
- Nakajima, N., Miyauchi, K., Yokoyama, T., Ogita, M., Miyazaki, T., Tamura, H., Nishino, A., Yokoyama, K., Okazaki, S., Kurata, T., Suwa, S., & Daida, H.
- Affiliations
- Juntendo University (JP)
- Juntendo University Shizuoka Hospital (JP)
- Corresponding author
- Miyauchi, Katsumi
- ORCID
- Venue
- IJC Metabolic & Endocrine
- Publisher
- Elsevier BV
- Published
- 2014-06
- Volume
- 3
- Pages
- 8-13
- ISSN
- 2214-7624 (ISSN-L)
- OpenAlex
- W2061063342
- Cited by
- 37
- References
- 23
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 10 · 2023: 1 · 2022: 4 · 2020: 3 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 1
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- IJC Metabolic & Endocrine (publishedVersion, cc-by-nc-nd)
- Funders
- Bristol-Myers Squibb
- Pfizer
- Cell Science Research Foundation
- Takeda Pharmaceutical Company
- Kowa Company
- Shionogi
- Otsuka Pharmaceutical
- MSD K.K.
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Surgery › Cholesterol and Lipid Metabolism
- Keywords
- ezetimibe, atorvastatin, statin combination therapy, acute coronary syndrome, coronary plaque regression, plaque volume, intravascular ultrasound, LDL cholesterol lowering, non-culprit lesions, diabetes mellitus, percutaneous coronary intervention
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