title: Effects of atorvastatin and ezetimibe on endothelial function in dyslipidemic patients with chronic kidney disease.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a staple risk factor not only for renal failure but also for cardiovascular diseases. In addition, because dyslipidemia facilitates atherosclerosis and renal dysfunction, antihyperlipidemic treatment is important to prevent cardiac and renal events in CKD patients.
  
  
  METHODS
  We compared the effects of a statin and an intestinal cholesterol transporter inhibitor in 20 dyslipidemic patients with CKD presenting with proteinuria and/or glomerular filtration rate <60 mL/min/1.73 m(2). Either 5-10 mg atorvastatin or 10 mg ezetimibe was given for 3 months each in a randomized crossover manner and the parameters of oxidative stress, inflammation and endothelial function were compared.
  
  
  RESULTS
  Atorvastatin lowered serum low-density lipoprotein (LDL) cholesterol more prominently than ezetimibe (103 ± 38 vs 130 ± 45 mg/dL, p < 0.001), while serum γ-glutamyl transpeptidase was higher in atorvastatin than in ezetimibe (29 ± 16 vs 25 ± 11 U/L, p = 0.013). On the other hand, serum oxidized LDL and high-sensitivity C-reactive protein were lower in the atorvastatin treatment period than in the ezetimibe treatment period (109 ± 38 vs 146 ± 67 U/L, p = 0.002; 1.02 ± 1.46 vs 1.47 ± 1.77 µg/mL, p = 0.003). Although serum adiponectin was not significantly different between the two drugs, the reactive hyperemia index, an index of endothelial function, was higher in atorvastatin than in ezetimibe (1.94 ± 0.58 vs 1.60 ± 0.44, p = 0.023).
  
  
  CONCLUSIONS
  It is concluded that atorvastatin is more potent than ezetimibe in improving the serum lipid profile, reducing oxidative stress, suppressing inflammation and preserving endothelial function, while ezetimibe may be advantageous in reducing the hepatic lipid load.
authors.affiliation: Department of Cardiology and Nephrology, Dokkyo Medical University, Mibu, Tochigi, 321-0293, Japan, isimitu@dokkyomed.ac.jp.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Ishimitsu
authors.forename: Eri
authors.initials: E
authors.lastname: Ohno
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Ueno
authors.forename: Shou
authors.initials: S
authors.lastname: Onoda
authors.forename: Akihiko
authors.initials: A
authors.lastname: Nagase
authors.forename: Takehiro
authors.initials: T
authors.lastname: Ohira
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Nakano
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Satonaka
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000069059:Atorvastatin; D001384:Azetidines / Q000494:pharmacology / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D018592:Cross-Over Studies; D050171:Dyslipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004730:Endothelium, Vascular / Q000187:drug effects*; D000069438:Ezetimibe; D005260:Female; D006538:Heptanoic Acids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress / Q000187:drug effects; D011758:Pyrroles / Q000494:pharmacology / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*
chemical_list: D000924:Anticholesteremic Agents; D001384:Azetidines; D006538:Heptanoic Acids; D008055:Lipids; D011758:Pyrroles; D002097:C-Reactive Protein; D000069059:Atorvastatin; D000069438:Ezetimibe