Abstract
Introduction: Ezetimibe (EZE) is a cholesterol absorption inhibitor and its clinical benefit, as combined with statin for pts with coronary artery disease (CAD), was shown by IMPROVE-IT trial. Campesterol (camp) is the cholesterol absorption marker and the benefit of EZE/statin combination therapy for pts with low camp (LC) value, in whom EZE appears to ineffective, is not clearly understood. The PRECISE-IVUS (Plaque REgression with Cholesterol absorption Inhibitor or Synthesis inhibitor Evaluated by IntraVascular UltraSound) trial was a prospective, randomized, controlled, multicenter study evaluating the effects of EZE addition to atorvastatin (atorva), compared with atorva monotherapy, on coronary atherosclerosis evaluated by IVUS and lipid profile. Hypothesis: In this study, we investigated the effect of EZE for pts with the LC value. Methods: 246 pts undergoing IVUS-guided percutaneous coronary intervention were randomized to EZE/atorva combination (EA) group or atorva alone (A) group. The dosage of atorva was uptitrated with a treatment goal of lowering low-density lipoprotein cholesterol (LDL-C) below 70mg/dL. Serial volumetric IVUS was performed at baseline and 9–12 months follow-up to quantify the coronary plaque response in 202 patients. Results: There were significantly positive correlation between baseline LDL-C level and baseline camp value (R=0.399, p<0.01), but no significant difference between baseline camp value and the presence of prior statin use. Baseline LDL-C level was significantly lower in LC groups (LC group vs. high camp group; 100.2±25.5mg/dL vs. 116.8±23.5mg/dL, respectively, p<0.0001). In the LC group, the delta LDL-C ratio (follow up LDL-C - baseline LDL-C / baseline LDL-C) was significantly lower in EA group compared with A group (-37.2±16.2% vs. -23.4±25.1%, p=0,009) and EA group showed significantly greater reduction in delta percent atheroma volume, compared with A group (-2.2 [-4.1 to -0.1]% vs. -0.3 [-1.6 to 1.1]%, p=0.04). Conclusions: Even in pts with CAD and LC value, statin-EZE combined therapy showed significantly decreased LDL-C and regressed coronary plaque burden. Even if the cholesterol absorption ability is declined, EZE-statin combined therapy might be the promising option for pts with CAD.
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