Achieving the LDL‑cholesterol target levels in clinical practice. Information from the IN-CROSS study.
Authors:
H. Vaverková
Published in:
Kardiol Rev Int Med 2009, 11(2): 83-86
Overview
A number of interventional studies confirmed that reduction in LDL‑cholesterol (LDL‑C) leads to reduction in cardiovascular morbidity. Consequently, LDL‑C cholesterol is considered as the main target for lipid-lowering therapy in all international and national guidelines. The EUROASPIRE III study has shown that, even though nearly 80% of patients are treated with statins in the secondary prevention, the target levels for LDL‑C cholesterol are achieved in about half of these patients. There are several potential ways how to achieve lower LDL‑C levels: 1) increase the dose of the statin used, 2) switch to a more potent statin and 3) use a combined treatment. A number of patients do not tolerate high dose statins either due to the elevated liver enzymes or creatine kinase or due to clinical difficulties without obvious laboratory abnormities. The latter two options are thus often applied. With respect to this, the results of the recent IN-CROSS study are of interest. The IN-CROSS study compared reduction in LDL‑C achieved by switching the high risk patients who did not achieve the target LDL‑C levels on a stable statin dose to either the so far most potent statin rosuvastatin (ROSUVA) at a dose of 10 mg/day or the combined preparation ezetimibe/simvastatin (EZE/SIMVA) 10/20 mg/day. After 6 weeks of treatment, EZE/SIMVA was significantly more effective in decreasing LDL‑C levels than ROSUVA (further 11% reduction in LDL‑C). Administration of EZE/SIMVA led to significantly higher reduction in total cholesterol, non‑HDL‑C and apolipoprotein B. Adverse events rate was comparable in both groups. Significantly more patients achieved target LDL‑C levels < 2.59, < 2.0 and < 1.8 mmol/l with EZE/SIMVA than ROSUVA. The most significant differences in LDL‑C reduction were observed in patients who were on the most potent statin therapy prior to the study. The combined EZE/SIMVA therapy might help in achieving the target LDL‑C levels particularly in patients with inadequate response to statin therapy. The ongoing large studies will provide crucial results with respect to the impact of this therapy on the incidence of cardiovascular events.
Keywords:
ezetimibe – rosuvastatin – dyslipidemia – dual cholesterol inhibition – hypolipidemic drugs
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