Cor Vasa 2015, 57(4):e257-e264 | DOI: 10.1016/j.crvasa.2015.03.012

The possibility of reducing the Lp-PLA2 mass level using simvastatin monotherapy and combination therapy with ezetimibe

Sofia Vladimirovna Miklishanskaya^b,*, Tatyana N. Vlasik^a, Gregory I. Kheimets^a, Valeriy V. Kukharchuk^a

^a Institute of Cardiology, Russian Cardiology Research-and-Production Complex, Ministry of Health of the Russian Federation, Moscow, Russia

^b Russian Medical Academy of Postgraduate Education, Moscow, Russia

Aim: To assess the impact of combined treatment with simvastatin and ezetimibe or treatment with simvastatin only on lipoprotein-associated phospholipase A2 mass level in patients with coronary heart disease.

Methods: One hundred patients with angiographically documented coronary atherosclerosis took part in the investigation. Lp-PLA2 mass level and cholesterol fractions were determined at baseline and after 6 months of treatment. Lp-PLA2 mass was determined by PLAC Test; DiaDexus, Inc.

Results: Combined treatment with ezetimibe and simvastatin led to significantly greater declines in Lp-PLA2 and lipid profile compared with treatment only with simvastatin (p < 0.05). Combination therapy with ezetimibe and simvastatin 20 mg/day proved to be as effective as monotherapy with simvastatin 80 mg/day on the effect on Lp-PLA2 mass level and lipids (p < 0.05). Lp-PLA2 mass level was initially higher in patients with 3-vessel coronary artery disease, compared with patients with 1-vessel coronary artery disease while baseline levels of lipids and hs-CRP did not differ significantly.

Conclusions: Combined treatment, using half the dose of simvastatin, led to greater reduction of Lp-PLA2 mass level total cholesterol and LDL-C, compared to monotherapy with simvastatin. Due to the steady decline target levels of LDL-C, which leads to prescribing high doses of statins (and it is not always possible because of the presence of co-morbidities), combination therapy with statin and ezetimibe is a reliable alternative, which allows not only to largely reduce LDL-C but also to significantly reduce such important participants of atherosclerosis process and markers of inflammation, as Lp-PLA2 and CRP.

Keywords: Coronary heart disease; Ezetimibe; Lipoprotein-associated phospholipase A2; Simvastatin

Received: February 2, 2015; Revised: March 23, 2015; Accepted: March 25, 2015; Published: August 1, 2015  Show citation