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. 2017 Nov;14(5):4942-4950.
doi: 10.3892/etm.2017.5175. Epub 2017 Sep 21.

Comparison of the effect of rosuvastatin versus rosuvastatin/ezetimibe on markers of inflammation in patients with acute myocardial infarction

Yizhi Ren  1 , Hao Zhu  1   2 , Zhongguo Fan  1 , Yali Gao  1 , Nailiang Tian  1   2
Affiliations

Comparison of the effect of rosuvastatin versus rosuvastatin/ezetimibe on markers of inflammation in patients with acute myocardial infarction

Yizhi Ren et al. Exp Ther Med. 2017 Nov.

Abstract

Statins lower low-density lipoprotein cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP), and the addition of ezetimibe to statins further reduces LDL-C and hsCRP. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a potentially important pathogenic factor participating in the progression of atherosclerosis. The aim of current study was to investigate how the addition of ezetimibe to rosuvastatin treatment affects reductions in LDL-C, hsCRP and Lp-PLA2 in patients with acute myocardial infarction (AMI). A total of 135 patients were enrolled in the study within 24 h of AMI, and were randomized to receive 10 mg rosuvastatin or 10 mg rosuvastatin plus 10 mg ezetimibe daily. HsCRP, Lp-PLA2, total cholesterol (TC), triglycerides (TG), LDL-C and high-density lipoprotein cholesterol (HDL-C) were determined at baseline and after 1, 3, 6 and 12 months of treatment. The addition of ezetimibe to rosuvastatin led to greater reduction of LDL-C compared with rosuvastatin monotherapy (from 3.00 to 1.19 mmol/l vs. 2.93 to 1.49 mmol/l, respectively; P<0.05), as well as reduced levels of hsCRP (from 5.15 to 0.68 mg/l vs. 4.33 to 1.49 mg/l, respectively; P<0.05) and Lp-PLA2 (from 333.13 to 79.07 mg/l vs. 327.95 to 123.62 mg/l, respectively; P<0.05). A positive association was identified between reductions of Lp-PLA2 and the changes of LDL-C (r=0.367; P=0.002). However, no significant correlation was observed between changes in Lp-PLA2 and hsCRP (r=0.264; P=0.512). The values of hsCRP and Lp-PLA2 appeared to increase during the first week after randomization, but dropped steeply to a lower level and remained stable thereafter. In conclusion, the addition of ezetimibe to rosuvastatin was demonstrated to further reduce LDL-C, hsCRP and Lp-PLA2 compared with rosuvastatin monotherapy in patients with AMI.

Keywords: AMI; LDL-C; Lp-PLA2; ezetimibe; hsCRP; rosuvastatin.

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Figures

Figure 1.
Figure 1.
Flow diagram of study participants and their treatments. AMI, acute myocardial infarction.
Figure 2.
Figure 2.
LDL-C, Lp-PLA2 and hsCRP levels over time following randomized treatment. Plots of mean (A) LDL-C, (B) hsCRP and (C) Lp-PLA2 over time. LDL-C, low-density lipoprotein cholesterol; hsCRP, high-sensitivity C-reactive protein; Lp-PLA2, lipoprotein-associated phospholipase A2; R10, 10 mg rosuvastatin; R10+E10, 10 mg rosuvastatin plus 10 mg ezetimibe. Numerical values and standard deviations for the results in these plots are shown in Table II. *P<0.05 vs. corresponding baseline levels; &P<0.05 vs. R10 group.
Figure 3.
Figure 3.
Net changes from baseline to 12 months in (A) TC, LDL-C, HDL-C and TG, (B) hsCRP and (C) Lp-PLA2 following randomized treatment. *P<0.05 vs. R10. TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; TG, triglycerides; hsCRP, high-sensitivity C-reactive protein; Lp-PLA2, lipoprotein-associated phospholipase A2; R10, 10 mg rosuvastatin; R10+E10, 10 mg rosuvastatin plus 10 mg ezetimibe. Numerical values and standard deviations for the results in these plots are shown in Table III. *P<0.05 vs. R10 group.
Figure 4.
Figure 4.
Net changes from baseline to 12 months in Lp-PLA2 for prespecified subgroups. The subgroups were (A) sex and age ≥65 or <65 years, (B) diabetic status and smoking status, (C) STEMI or NSTEMI and dyslipidemia status. Lp-PLA2, lipoprotein-associated phospholipase A2; STEMI, ST-segment elevation myocardial infarction, NSTEMI, non-ST-segment elevation myocardial infarction; R10, 10 mg rosuvastatin; R10+E10, 10 mg rosuvastatin plus 10 mg ezetimibe.
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