Evidence for cholesterol hyperabsorbers and hyperproducers based on comparative low-density lipoprotein reductions achieved by ezetimibe versus statins.
OBJECTIVE
To investigate the hypothesis that some patients are hyperproducers of cholesterol while others are hyperabsorbers by comparing the low-density lipoprotein (LDL) responses to statins versus ezetimibe adjunct therapy.


METHODS
Consecutive patients (N = 109), who received statin monotherapy followed by ezetimibe adjunct therapy, were prospectively studied. The expected LDL levels for each patient on statin and on ezetimibe adjunct therapy were calculated. The difference between expected and actual LDL levels on statin and on ezetimibe adjunct therapy was calculated for each patient and subsequently correlated.


RESULTS
The mean LDL levels (mg/dL) were baseline, 168.7 ± 3.6; on statin, 104.2 ± 2.6; on ezetimibe adjunct, 74.2 ± 2.2. Statins reduced LDL by 36.7 ± 1.5%, while adding ezetimibe resulted in a further reduction of 28.1 ± 1.4%. The percent LDL reduction by statin was negatively correlated to the percent reduction by ezetimibe adjunct therapy (r = -0.29, P = .002). The difference between expected and actual LDL levels on statin was negatively correlated to that on ezetimibe adjunct therapy (r = -0.38, P < .001).


CONCLUSIONS
This study demonstrated that the LDL response to ezetimibe is inversely related to the response to statin. This lends support to the hypothesis that some patients may be hyperabsorbers of cholesterol while others may be hyperproducers. This suggests that a less than expected response to the initial dose of statin in a patient would likely require the addition of ezetimibe to achieve the recommended target levels in spite of the use of maximum dose statin therapy.
Division of Cardiology, Grey Nuns Hospital, University of Alberta, Edmonton, Canada.
Janek
J
Senaratne
Jo
J
Griffiths
Karen
K
MacDonald
Manohara P J
MP
Senaratne
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001384:Azetidines / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000097:blood / Q000378:metabolism*; D000069438:Ezetimibe; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D006937:Hypercholesterolemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D013223:Statistics as Topic
D000924:Anticholesteremic Agents; D001384:Azetidines; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000069438:Ezetimibe