Effect of Atorvastatin Monotherapy and Low-Dose Atorvastatin/Ezetimibe Combination on Fasting and Postprandial Triglycerides in Combined Hyperlipidemia

Abstract

Lee at al¹ report that atorvastatin + ezetimibe (5 + 5 mg/d) combination was more effective than atorvastatin (20 mg/d) monotherapy in lowering fasting and postprandial triglyceride (TG) levels. Some comments regarding this may be of interest.

Ezetimibe can enhance the hypotriglyceridemic effect of statins. In a meta-analysis (5039 patients), ezetimibe 10 mg/d on top of statin treatment was associated with an additional decrease in TG levels by 10.7% (P < .0001).² According to our experience, the TG-lowering effect of ezetimibe is positively correlated with the baseline TG levels.^3,4 Therefore, we would like to know whether in the Lee et al study,¹ TG lowering was greater in the upper tertile of TG values than that in the lower ones.

Raised TG levels are associated with a predominance of small dense low-density lipoprotein particles that are more atherogenic.⁵ The cholesterol of these subfractions can be reduced by both statins and ezetimibe.^6
–8 Interestingly, TG levels appear to influence this effect.^6,7

The findings of Lee at al¹ are relevant because there is evidence that both fasting and postprandial TG levels predict vascular risk.⁹

References

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Chung

Choi

. Effect of Atorvastatin Monotherapy and Low-Dose Atorvastatin/Ezetimibe Combination on Fasting and Postprandial Triglycerides in Combined Hyperlipedemia. J Cardiovasc Pharmacol Ther. 2012;17(1):65–71.

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