Diabetes influences lipid-lowering effects of combination therapy
MedWire News: The lipid-lowering effects of combination therapy, compared with statin monotherapy, differ for patients with and without diabetes, research suggests.
Lawrence Leiter (University of Toronto, Ontario, Canada) and colleagues say that in patients both with and without diabetes, combination therapy (ezetimibe 10 mg plus a statin) provided larger reductions in low-density lipoprotein (LDL) cholesterol, total cholesterol, triglycerides, non-high-density lipoprotein (non-HDL) cholesterol, apolipoprotein (apo)B, and high-sensitivity C-reactive protein (hs-CRP) than did statin monotherapy.
However, they note that in patients with diabetes, reductions in LDL cholesterol, total cholesterol, and non-HDL cholesterol were significantly larger than in patients without diabetes.
Using data from 27 previously published clinical trials, the team examined changes in lipid levels after 4-24 weeks of ezetimibe/statin treatment or statin monotherapy in patients with (n=6541) and without (n=15,253) diabetes.
Compared with statin monotherapy, combination therapy led to a 16.1% greater reduction in LDL cholesterol, 10.6% in total cholesterol, 4.7% in triglycerides, 14.3% in non-HDL cholesterol, 11.4% in apoB, and 8.7% in hs-CRP, and a 1.7% and 0.8% greater increase in HDL cholesterol and apo A-1, respectively, from levels measured at baseline in all patients, and in diabetic and nondiabetic subgroups.
In diabetic patients, reductions in LDL, total, and nonHDL cholesterol were significantly greater than in nondiabetic patients, at 17.4% versus 14.9%, 11.0% versus 10.2%, and 15.0% versus 13.6%, respectively. Between-group differences were similar for changes in triglycerides, HDL cholesterol, apoB, and hs-CRP, however.
Writing in the journal Diabetes, Obesity, and Metabolism, Leiter and team say that the clinical relevance of the enhanced lipid-lowering effects of combination therapy that they observed in diabetes patients remains to be proven in clinical trials.
"It would be of interest to compare the results of ezetimibe/statin versus statin-only in patients with Type 1 versus Type 2 diabetes," they add.
The researchers note that both treatments were generally well tolerated in the overall population, regardless of diabetes status.
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By Nikki Withers