UVA School of Medicine

RESEARCH gr Doubts about Ezetimibe New UVA study questions health benefits of commonly prescribed cholesterol-lowering medication in some patients M ore than 42 million Americans suffer from high cholesterol, and 63 million more have border- line high cholesterol. Over time, high levels of LDL cholesterol, often called "bad cholesterol," build up along the walls of arteries and blood vessels, a process called atherosclerosis, which can lead to a high risk of heart disease, stroke and heart attack. For some patients with high choles- terol, physicians routinely prescribe the combination of two cholesterol-low- ering medications—statin therapy plus ezetimibe. A new study by University of Virginia Health System researchers, however, adds to mounting evidence that ezetimibe may not halt significant artery wall thickening, or atherosclerosis, in some patients. Despite the medica- tion's proven effectiveness in lowering LDL cholesterol, UVA researchers found a notable progression of atherosclerosis in patients who added ezetimibe to their pre-existing cholesterol-lowering statin medication therapy. The UVA study, now published online in the journal Atherosclerosis, follows two major clinical studies in 2008 and 2009 that also raised doubts about the benefits of ezetimibe in patients suffering from high LDL cholesterol levels, atherosclero- sis and other heart-related problems. "Patients in our study who had ezetimibe added to pre-existing statin therapy experienced on average a 22 percent decrease in their LDL cholesterol 6 Vitals Fall 2011 [Studies] found that in these patients, atherosclerosis progressed at a rate of four percent per year over the two- year study period. That's a troubling rate of progression that occurred, despite the fall in cholesterol. levels; however, we found that in these patients, atherosclerosis progressed at a rate of four percent per year over the two-year study period. That's a troubling rate of progression that occurred, despite the fall in cholesterol," says lead author Christopher M. Kramer, MD, professor of radiology and medicine in the UVA School of Medicine and director of the UVA Cardiovascular Imaging Center. Kramer's study used magnetic reso- nance imaging (MRI) to measure plaque buildup in the arteries of patients with peripheral arterial disease (PAD), who were treated with cholesterol-lowering medication for the two-year study period. PAD is a circulatory problem in which narrowed arteries reduce blood flow to limbs, most commonly to the legs. UVA researchers investigated two different study groups over the two-year trial period. One study group involved 34 PAD patients who had not previously been on any statin therapy. Statins are the most widely-accepted and prescribed standard medication therapy for lowering cholesterol. This group was randomized to begin treatment with either 40 mg of simvastatin or 40 mg of simvastatin plus 10 mg of ezetimibe. In both of these patient subsets, atherosclerosis progres- sion was halted. The second study group involved 33 PAD patients who were already on statin therapy for at least one year and who had LDL cholesterol levels at or above 80 mg/dl. For this second study group, researchers added 10 mg ezetimibe to

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