Therapy and clinical trials

Abstract

In the VYTAL (Vytorin versus Atorvastatin in Patients with Type 2 Diabetes Mellitus and Hypercholesterolemia) study, Goldberg et al. [2 •• ] compared the usual starting doses of ezetimibe/simvastatin (10/20 mg/day) with those of atorvastatin (10 or 20 mg/day), and the next highest doses of these agents (ezetimibe/simvastatin 10/40 mg/day versus atorvastatin 40 mg/day) over 6 weeks. In their double-blind multicenter study, the investigators demonstrated a significantly greater mean reduction in LDL-cholesterol levels with ezetimibe/simvastatin 10/20 mg/day (53.6%) than with atorvastatin 10 mg/day (38.3%) or 20 mg/day (44.6%). Also, they found that ezetimibe/simvastatin 10/40 mg/day yielded a greater reduction in LDLcholesterol (57.6%) than did atorvastatin 40 mg/day (50.9%). The combination therapy at both doses was superior to atorvastatin with respect to the increase in HDL-cholesterol levels and decrease in non-HDL-cholesterol levels. With regard to plasma triglycerides and highsensitivity CRP levels, however, the reduction in levels was significant only for the 10/20 mg/ day dose of ezetimibe/simvastatin. Although only the 10/20 mg dose of ezetimibe/simvastatin was superior to atorvastatin in terms of reducing LDL-cholesterol to below 100 mg/dl,