Volume 194 - Issue 1
Managing residual risk in patients receiving statin therapy
Author: Brett H Forge
Med J Aust 2011; 194 (1): 54. || doi: 10.5694/j.1326-5377.2011.tb04159.x
Published online: 3 January 2011
Published online: 3 January 2011
To the Editor: I would like to endorse the letter by Montgomery1 questioning the efficacy of ezetimibe. As yet there are no data to support its use in clinical trials using carotid intima media thickness (CIMT) as a measure of treatment effectiveness, and there is also some evidence to suggest it could be harmful.
A randomised trial conducted by Berneis et al2 suggested that ezetimibe may induce an unfavourable pro-atherogenic low-density lipoprotein (LDL) subfraction profile by increasing small, dense LDLs.
The Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) trial3 compared simvastatin/ezetimibe 40/10 mg daily with placebo, so any benefit from that treatment may have been from either the ezetimibe or the simvastatin. It tells us nothing about the effectiveness of ezetimibe alone.
Until the results of clinical trials are available, I believe ezetimibe should be used with much reluctance and only considered as a last resort. I agree with Hamilton-Craig4 that it is a matter of concern that slow-release niacin, which is effective and safe, is not available under the Pharmaceutical Benefits Scheme in Australia. Searching for supplies of this drug in Australia or overseas seems the best option for treating patients whose levels of LDL cholesterol are inadequately controlled with statin therapy.
References
- Montgomery BD. Managing residual risk in patients receiving statin therapy [letter]. Med J Aust 2010; 193: 375.
- Berneis K, Rizzo M, Berthold HK, et al. Ezetimibe alone or in combination with simvastatin increases small dense low-density lipoproteins in healthy men: a randomized trial. Eur Heart J 2010; 31: 1633-1639. 0_i1095832
- Rossebø AB, Pedersen TR, Allen C, et al. Design and baseline characteristics of the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. Am J Cardiol 2007; 99: 970-973. 0_CBBJFCJH
- Hamilton-Craig IR. Managing residual risk in patients receiving statin therapy [letter]. Med J Aust 2010; 193: 375-376. 0_CBBBJDGD