[en] Statins reduce both LDL cholesterol (LDL-C) levels and the risk of cardiovascular events in patients with and without cardiovascular disease. Intensive statin therapy, compared with moderate-dose statin therapy, incrementally lowers LDL-C levels and rates of cardiovascular events in patients presenting with acute coronary syndrome. Ezetimibe, by diminishing the absorption of cholesterol from the intestine, additionally reduces LDL-C when added to statins. In this article, we discuss the potential benefits of the combination of simvastatin and ezetimibe for the long-term management of patients with acute coronary syndrome through an analysis of the IMPROVE-IT results (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial). This randomised double blind trial included 18,144 patients with a LDL-C of 50 to 100 (with statin) or 125 (without statin) mg/dl and had a median follow-up of 6 years. The objective of the study was to test the efficacy of simvastatin 40 mg versus simvastatin 40 mg and 10 mg ezetimibe. The primary endpoint included cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina and coronary revascularization. The addition of ezetimibe to simvastatin resulted in an incremental lowering of LDL-C (reached value 53.2 versus 69.9 mg/dl, p < 0.001) and a further improvement of the patient prognosis (relative reduction of primary endpoint: -6.4%, p = 0.016). In addition, the combined therapy showed no significant adverse effects, particularly regarding the risk of cancers, which confirms the safety of ezetimibe. In acute coronary syndrome, the prescription of ezetimibe should be considered (class HA, level of evidence B) in patients with a LDL-C a 70 mg/dl despite maximally tolerated dose of statin. [fr] Résumé : Les statines réduisent à la fois le niveau de cholestérol
LDL (LDL-C) et le risque d’événements cardiovasculaires
chez les patients avec ou sans maladie cardiovasculaire.
Le traitement intensif par statine, à dose élevée par rapport
à une dose modérée, diminue davantage la concentration de
LDL-C et le taux d’événements cardiovasculaires chez les
patients présentant un syndrome coronarien aigu. L’ézétimibe,
en diminuant l’absorption du cholestérol dans l’intestin,
entraîne une diminution supplémentaire du taux de LDL-C
lorsqu’il est ajouté à une statine. Dans cet article, nous examinons
les avantages potentiels de la combinaison simvastatine/
ézétimibe pour la prise en charge à long terme des patients
atteints d’un syndrome coronarien aigu à travers une analyse
des résultats de l’étude IMPROVE-IT («IMProved Reduction
of Outcomes: Vytorin Efficacy International Trial»). Cette
étude randomisée en double aveugle a inclus 18.144 patients
avec un taux de LDL-C de 50 à 100 (sous statine) ou 125 (sans
statine) mg/dl et a assuré un suivi médian de 6 ans. L’objectif
était de tester l’efficacité de la simvastatine 40 mg vis-à-vis de
l’association simvastatine 40 mg et ézétimibe 10 mg. Le critère
primaire comportait les décès cardiovasculaires, l’infarctus
du myocarde, l’accident vasculaire cérébral, les hospitalisations
pour angor instable et les revascularisations coronaires.
L’ajout d’ézétimibe au traitement a entraîné une chute plus
marquée du LDL-C (valeur atteinte 53,2 versus 69,9 mg/dl,
p < 0,001) et une amélioration supplémentaire du pronostic
des patients (réduction du risque relatif de survenue du critère
principal: - 6,4 %, p = 0,016). Cette bithérapie n’a pas
montré d’effet indésirable significatif, en particulier en ce qui
concerne les cancers, ce qui confirme la sécurité d’emploi de
l’ézétimibe. Dans le syndrome coronarien aigu, la prescription
d’ézétimibe doit être envisagée (classe IIA, niveau d’évidence
B) chez les patients avec un LDL-C ≥ 70 mg/dl malgré une
dose maximale tolérée de statine
Disciplines :
Pharmacy, pharmacology & toxicology Cardiovascular & respiratory systems
Author, co-author :
Lancellotti, Patrizio ; Université de Liège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Pierard, Luc ; Université de Liège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
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