Statin combination reveals ‘biggest ever’ cholesterol drop

A combination treatment regime of rosuvastatin (Crestor) 40mg and ezetimibe 10mg has been hailed as a new option for high-risk patients.

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By  Joanne Bladd Published  July 10, 2006

A combination treatment regime of rosuvastatin (Crestor) 40mg and ezetimibe 10mg has been hailed as a new option for high-risk patients, after reportedly producing a 70% reduction in LDL-C, the largest seen in a statin clinical trial to date. According to researchers on the Explorer study, 94% of high-risk patients treated with the drug combination achieved their optimal cholesterol goal of 100mg/dL or less within six weeks. Only 79% of those treated with rosuvastatin alone achieved the same drop in LDL-C levels. The findings were presented at the International Symposium on Atherosclerosis. To date, statins have been shown to effectively reduce LDL-C, enabling many patients to successfully achieve guideline goals. However, a small group of patients, particularly high-risk patients with very high LDL-C, are unable to lower their cholesterol on the maximum statin dose. Experts hope combination therapy will prove to offer another treatment option. Professor Christie Ballantyne, Baylor College of Medicine, Houston, was the lead investigator on the Explorer study. “Cardiologists have long recognised the challenge in helping patients with dangerously high cholesterol levels, and especially the high-risk patient with high cholesterol, reach their target lipid levels,” she said. “Several studies have already demonstrated that rosuvastatin, as a statin monotherapy, is highly effective at lowering elevated cholesterol levels. Explorer now shows that a treatment regimen using rosuvastatin as a base and adding-on ezetimibe can help even difficult to treat patients achieve optimal cholesterol targets.” In separate news, a major international study was announced this week to trial a treatment aimed at raising HDL levels. Led by a team from Oxford University, who previously carried out the landmark Heart Protection study, researchers will trial HDL-raising agents alongside baseline statin therapy. The active ingredient in the trial drug is niacin, which has been shown to increase levels of HDL by between a fifth and a quarter. But patients have found it difficult to take long-term, because it produces an uncomfortable side-effect of flushing. To combat this, niacin has been combined with another drug to block the release of prostaglandin D2. Over 20,000 volunteers are taking part, all aged between 50 and 80 with a history of stroke, heart attack or peripheral artery disease. Dr Jane Armitage, lead investigator, said: “The difficulty has been that there haven’t been good quality drugs that raise HDL very much. “The trial will be in people at risk of future heart problems, despite the fact that their LDL cholesterol has been lowered. If it’s shown to work, the epidemiology suggests it will be possible for people at lower risk of heart problems to benefit,” she said. Professor Gilbert Tompson, a lipidology expert at Imperial College, London, called the trial “the next step” in cholesterol research, but warned the findings might not be conclusive. “It seems a perfectly reasonable approach, but it won’t necessarily give you a straight answer about HDL, because niacin also lowers triglyceride. But it will be a good trial.” Several current trials follow the protocol of adding HDL-raising agents to baseline statin therapy. A separate drug group, CETP inhibitors, have also been shown to increase HDL levels.

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