Age-Dependent Efficacy of Ezetimibe for Low-Density Lipoprotein Cholesterol Reduction in Japanese Patients with or without Type 2 Diabetes Mellitus.

Satoshi Yamaguchi,Moritake Higa,Osamu Arasaki,Michio Shimabukuro,Kageyuki Oba

doi:10.3390/jcm9061675

Abstract

Ezetimibe reduces cardiovascular risk by lowering the levels of low-density lipoprotein cholesterol (LDL-C). However, there is limited information regarding the factors associated with ezetimibe-mediated LDL-C reduction. We investigated the factors associated with LDL-C reduction after ezetimibe administration in Japanese patients with or without type 2 diabetes mellitus (T2DM). This single-center retrospective observational study enrolled a total of 266 consecutive ezetimibe-naïve patients, of which 154 were excluded because of either switching from statin or fenofibrate to ezetimibe (n = 52) or ezetimibe discontinuation (n = 102). Finally, 112 patients were eligible for analysis. To identify the factors influencing LDL-C levels, univariate and multivariate linear regression analyses were performed after 52 weeks of ezetimibe treatment. Overall, advanced age, T2DM, and high baseline LDL-C were significantly associated with a greater decrease in LDL-C levels. In the non-T2DM group, advanced age and high baseline LDL-C were associated with greater decrease in LDL-C levels. In the T2DM group, baseline LDL-C was the only factor that influenced the change in LDL-C levels. Advanced age was significantly associated with higher LDL-C reduction in non-T2DM patients, but not in T2DM patients. Ezetimibe use might be beneficial in older patients without T2DM. The lack of association between age and the LDL-C lowering effect by ezetimibe in patients with T2DM may be due to yet unknown mechanism except low statistical power.

Highlights

Hyperlipidemia accelerates the progression of atherosclerosis and raises the risk of cardiovascular diseases [1]
Gender, type 2 diabetes mellitus (T2DM), hypertension, coronary artery disease, statin pretreatment, and baseline low-density lipoprotein cholesterol (LDL-C) of the patients using univariate linear regression analysis, to identify the factors associated with the change in LDL-C after ezetimibe treatment in the overall population and stratified them under T2DM or non-T2DM
There were no significant differences in age, gender, body weight, and body mass index between the patients with and without T2DM

Summary

Introduction

Hyperlipidemia accelerates the progression of atherosclerosis and raises the risk of cardiovascular diseases [1]. An hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitor, is irrefutably the first line pharmacological therapy that is used for lowering low-density lipoprotein cholesterol (LDL-C) levels [2,3] and reducing the risk of cardiovascular events [1,2,3,4]. Statin is the most widely used therapeutic agent for hyperlipidemia; some patients still exhibit significant residual cardiovascular risks [5]. A series of randomized control trials [6] have confirmed that aggressive LDL-C reduction is beneficial to combat residual cardiovascular risk.

Methods

Discussion

Conclusion