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Fluvastatin/fenofibrate vs. simvastatin/ezetimibe in patients with metabolic syndrome: different effects on LDL‐profiles
Author(s) -
Winkler K.,
Schewe T.,
Pütz G.,
Ödünc N.,
Schäfer G.,
Siegel E.,
Geisen U.,
Abletshauser C.,
Hoffmann M. M.
Publication year - 2009
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2009.02126.x
Subject(s) - simvastatin , fenofibrate , ezetimibe , fluvastatin , metabolic syndrome , medicine , pharmacology , lovastatin , statin , cholesterol , endocrinology , diabetes mellitus
Background Patients with metabolic syndrome (MS) and type 2 diabetes (T2DM) show increased risk for coronary artery disease. Lipoprotein metabolism is characterized by elevated triglycerides (TG), low high‐density lipoprotein cholesterol (HDL‐C) and predominance of atherogenic small, dense low‐density lipoprotein (sdLDL), while low‐density lipoprotein (LDL) cholesterol is only slightly elevated. Methods Multicentre, randomized, open‐label cross‐over study investigating the effect of combination of fluvastatin/fenofibrate (80/200 mg) (F&F) on LDL‐subfractions compared with combination of simvastatin/ezetimibe (20/10 mg) (S&E) in patients with MS/T2DM. Results Seventy‐five patients were randomized, 69 completed the study and LDL‐subfractions of 56 patients were analysed. Thirty‐eight out of 56 patients (68%) showed a profile dominated by sdLDL. In these, TG and total cholesterol (TC) were elevated compared with non‐sdLDL patients. In all patients, reduction of TC and LDL cholesterol (LDL‐C) by S&E was stronger than by F&F. The increase of HDL‐C was stronger with S&E in the non‐sdLDL group, whereas in the sdLDL group, there was no difference between treatments. In non‐sdLDL patients, there was no effect on TG or LDL‐radius. However, in the sdLDL group, F&F was more effective in reducing TG and increased LDL radius, whereas S&E reduced LDL radius even further. Conclusions S&E is more efficient in reducing TC and LDL‐C. This is also true for HDL‐C increase in non‐sdLDL patients. However, in patients with sdLDL, F&F was more efficient in reducing TG and increasing LDL radius.