Attainment of Dual Treatment Levels for High-Sensitivity C-Reactive Protein and Lipids in Older (>65 Years) Patients with Cardiovascular Disease Risk: Ezetimibe/Simvastatin Versus Atorvastatin

Abstract

Synopsis: Although low-density lipoprotein cholesterol (LDL-C) lowering remains the primary aim of lipid-lowering therapy in patients with cardiovascular disease (CVD), guidelines additionally recommend non-high-density lipoprotein cholesterol (HDL-C) and apolipoprotein B (apoB) as secondary treatment targets in greater-risk patients. High-sensitivity C-reactive protein (hsCRP) is an inflammatory marker considered to be predictive of CVD. However, few data exist regarding the relationships between therapeutic changes in lipoproteins and reduction of hsCRP or achievement of dual targets in older patients. Purpose: This analysis compared the effects of ezetimibe/simvastatin (E/S) and atorvastatin (A) on attainment of single and dual treatment levels of hsCRP and LDL-C, hsCRP and non-HDL-C, and hsCRP and apoB in older patients (≥65 years) with moderately high/high CHD risk. Methods: Post-hoc analysis of a randomized, double-blind, 12-week (Vytorin in the Elderly [VYTELD]) study in 1054 hyperlipidemic patients ≥65 years of age. Attainment of specified single and dual treatment levels of hsCRP (<2 mg/L) and LDL-C (<70 and <100 mg/dL), non-HDL-C (<100 and <130 mg/dL), and apoB (<80 and <90 mg/dL) was assessed in patients who had baseline and 12-week levels of hsCRP ≤10 mg/L, pooled across doses of E/S (10/20, 10/40 mg) and A (10, 20, 40 mg). Attainment of single and dual levels of hsCRP and non-HDL-C and apo B also was assessed in patients with triglycerides <200 and ≥200 mg/dL. Results: Greater proportions of patients achieved the specified single levels of LDL-C (<70 and <100 mg/dL), non-HDL-C (<100 and <130 mg/dL), and apoB (<80 and <90 mg/dL) on E/S compared with A treatment, whereas attainment rates for hsCRP (<2 mg/L) were similar for both treatments (see Table footnote). Dual attainment of the specified levels of hsCRP and LDL-C, hsCRP and non-HDL-C, and hsCRP and apoB was greater with E/S treatment compared with A. Patients with baseline triglycerides <200 mg/dL generally had greater attainment rates than those with triglycerides ≥200 mg/dL, except attainment of dual hsCRP <2 mg/L and non-HDL-C <130 mg/dL levels, which was somewhat lower for E/S treatment in patients with triglycerides <200 mg/dL versus ≥200 mg/dL. Conclusions: E/S provides a therapeutic option not only for lowering LDL-C but also non-HDL-C, apoB, and hs-CRP levels in older hyperlipidemic patients. Although the attainment of hsCRP <2 mg/dL was comparable for E/S and A, attainment of dual treatment levels of hsCRP (<2mg/L), LDL-C, non-HDL-C, and apoB was greater with E/S treatment compared with A. Whether these results will translate into clinical outcomes in older adults remains to be determined.