The VYtorin on Carotid intima-media thickness and overall arterial rigidity (VYCTOR) study.
This study assessed the effect of 3 lipid-lowering therapies on the reduction of the carotid intima-media thickness (IMT) in high-risk coronary Mexican patients. The study was a randomized, comparative, and open clinical trial. Ninety high-risk coronary patients were allocated to 3 groups: pravastatin 40 mg, simvastatin 40 mg, and simvastatin 20 mg and ezetimibe 10 mg initially. If the therapeutic goals were not attained (<100 mg/dL of low-density lipoprotein cholesterol [LDL-C] for type C and <70 mg for type D), patients in group 1 received pravastatin 40 mg and ezetimibe 10 mg, group 2 received simvastatin 80 mg, and group 3 received simvastatin 40 mg and ezetimibe 10 mg. The primary endpoint was the change of IMT over the course of 1 year. The secondary endpoints were changes in LDL-C and in high sensitive C-reactive protein (CRPhs). The overall baseline IMTs generated by combining measurements in the internal carotid artery were 1.33+/-0.32 mm, 1.30+/-0.11 mm, and 1.23+/-0.28 mm for groups 1, 2, and 3, respectively. After 1 year, IMT values were 0.93+/-0.13 mm, 0.90+/-0.11 mm, and 0.92+/-0.01 mm for groups 1, 2, and 3, respectively. At the end of the study, LDL-C levels were 48+/-41, 45+/-37, and 48+/-31 in groups 1, 2, and 3, respectively. No significant differences were observed in CRP, high-density lipoprotein cholesterol, triglycerides, blood pressure, and body mass index, among the groups. This study is one of the first providing evidence that dual therapy has a beneficial effect on a surrogate marker of atherosclerosis.
Meaney
Alejandra
A
Cardiovascular Unit, Regional Hospital, 1 de Octubre, ISSSTE, Mexico. ameaney@cinvestav.mx
Ceballos
Guillermo
G
Asbun
Juan
J
Solache
Gustavo
G
Mendoza
Emma
E
Vela
Agustín
A
Meaney
Eduardo
E
D000328:Adult; D000368:Aged; D000924:Anticholesteremic Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001384:Azetidines / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000378:metabolism; D002343:Carotid Artery, Internal / Q000187:drug effects* / Q000473:pathology*; D002784:Cholesterol / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000175:diagnosis; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D000069499:Ezetimibe, Simvastatin Drug Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019821:Simvastatin / Q000494:pharmacology* / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood; D017539:Tunica Intima / Q000187:drug effects* / Q000473:pathology*; D017540:Tunica Media / Q000187:drug effects* / Q000473:pathology*
D000924:Anticholesteremic Agents; D001384:Azetidines; D004338:Drug Combinations; D000069499:Ezetimibe, Simvastatin Drug Combination; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol; D019821:Simvastatin