Evaluation of lipid lowering ability of atorvastatin and ezetimibe combination as compared with atorvastatin monotherapy

Kalpana S. Dudhal, Tushar R. Bapat, Amit A. Bansode


Background: Many patients on statin therapy do not achieve recommended LDL cholesterol goals. They require either high dose statin regimen or combination of statins with other lipid modifying agents. Ezetimibe is a novel drug when added to statins, will provide additional reduction in LDL-C level.

Methods: Total 100 patients with CHD or hypertension and having serum LDL-C levels of ≥100 mg/dl were enrolled for the study and were randomly allocated to two groups. Baseline investigations done. Patients from Group I received Atorvastatin (10mg) per day orally and patients from group II received combination of Atorvastatin (10mg) and Ezetimibe (10mg) per day orally. Study treatment was started on the day of randomization and continued for 12 weeks and follow up visits were scheduled at 4, 8, and 12 weeks. During each follow up investigations repeated and patients were interviewed and examined for occurrence of any adverse effect.

Results: There was greater reduction in levels of LDL-C, Total cholesterol and serum triglycerides in patients treated with Atorvastatin plus Ezetimibe combination as compared to those patients treated with Atorvastatin alone. This difference in percentage reduction in LDL-C, Total cholesterol and serum triglycerides levels in two groups was highly significant at 4, 8 and 12 weeks (p<0.01).

Conclusions: Addition of Ezetimibe to Atorvastatin offers a very effective and well tolerated option for patients with CHD and hypertension having LDL-C levels of >100mg/dl as it significantly lowers the LDL-C along with total cholesterol and triglycerides.


Hyperlipidemia, Lipoproteins, Low density lipoprotein cholesterol, Statins

Full Text:



WHO. The global burden of disease: 00 update. Geneva: World Health Organization; 2008.

Huffman MD. Coronary Heart Disease in India. Center for Chronic Disease Control:1. Available at: CHD.pdf. [Accessed on:2012 July 3].

Brunton LL, Chabner BA, Knollmann BC, Editors. Goodman and Gilman’s, The Pharmacological Basis of Therapeutics. 12th Edition, McGraw Hill, New York; 2011:877-908.

Davidson M, McGarry T, Bettis R. Ezetimibe co-administered with simvastatin in patients with primary hypercholesterolemia. J Am Coll Cardiol. 2002;40:2125-34.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.

Dan L, Anthony F, Dennis K, Stephen H , Jameson J. Editors Harrison Principal of Internal Medicine. 18th edition, MacGraw Hill New York, 2011;3145-3161.

Dipiro TJ, Talbert RL, Yee GC, Matzake GR, Wells BG, Posey LM, Editors. Pharmacotherapy A Pathophysiologic Approach. 7th Edition, McGraw Hill, New York; 2008:385-407.

Ballantyne CM, Houri J, Notarbartolo A, Melani L, Lipka LJ, Ramachandran S et al. Effect of ezetimibe coadministered with atorvastatin in 628 patients with primary hypercholesterolemia: A prospective, randomized, double-blind trial. Circulation. 2003;107:2409-15.

Margarita GC, Lisnock JM, Bull HG, Hawes BE, Burnett DA, Braun MP. The target of ezetimibe is Niemann–Pick C1-Like 1 (NPC1L1). PNAS. June 7, 2005;102(23):8132-37.

Davis HR, Compton DS, Hoos L, Tetzloff G. Ezetimibe, a potent cholesterol absorption inhibitor, Inhibits the development of atherosclerosis in ApoE knockout mice. Arterioscler Thromb Vasc Biol. 2001;21:2032-38.

Cannon CP, Braunwald E, Carolyn H, McCabe BS, Rader DJ, Rouleau JL et al. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes. N Eng J Med. 2004;350:1495-504.

Takemoto M, Node K, Nakagami H, Liao Y, Grimm M, Takemoto Y et al. Statins as antioxidant therapy for preventing cardiac myocyte hypertrophy. J. Clin. Invest. 2001;108:1429-37.

Ali FY, Armstrong PCJ, Dhanji R, Tucker AT, Clark MJP. Antiplatelet actions of statins and fibrates are mediated by PPARs. Arterioscler Thromb Vasc Biol. 2009;29:706-11.

Milda T, Hirayama S, Nakamura Y. Cholesterol- independent effects of statins and new therapeutic targets: Ischemic stroke and Dementia. J Atheroscler Thomb. 2004;11:253-64.

Liao JK. Effects of statins on 3-hydroxy-3-methylglutaryI coenzyme A reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol. 2005;96:24-33.

Tandon V, Bano G, Khajuia V, Parihar A, Gupta S. Pleiotropic effects of statins. Indian J Pharmacol. 2005;37;2:77-85.

Feldman T, Koren M, Insull W, Mckenney J, Schrott H, Lewin A et al. Treatment of high-risk patients with ezetimibe plus simvastatin co-administration versus simvastatin alone to attain National Cholesterol Education Program Adult Treatment Panel III low-density lipoprotein cholesterol goals. Am J Cardiol. 2004;93(12):1481-86.