Abstract
Ezetimibe/simvastatin therapy combines two lipid-lowering compounds with complementary mechanisms of action, thereby blocking the two sources of plasma cholesterol and improving lipid profiles. Ezetimibe/simvastatin is an effective and generally well tolerated adjunct to dietary therapy for markedly reducing lowdensity lipoprotein cholesterol (LDL-C) levels and improving other lipid parameters across diverse patient populations. Dual treatment with ezetimibe/simvastatin is more effective than monotherapy with an HMG-CoA reductase inhibitor (statin), and the addition of ezetimibe to current statin therapy is more effective than doubling the statin dose.
Similar content being viewed by others
References
National Cholesterol Education Program Expert Panel. 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): final report. Circulation 2002 Dec 17. 106 (25): 3143–421.
The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J 2011; 32: 1769–818.
Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Eur J Cardiovasc Prev Rehabil 2007; 14 Suppl. 2: S1–113.
Marques da Silva P, Massano Cardoso S, DYSIS Portugal Investigators. Persistent lipid abnormalities in patients treated with statins: Portuguese results of the Dyslipdemia International Study (DYSIS). Rev Port Cardiol 2011; 30(1): 47–63.
Drexel H, Chazelle F, Fauer C, et al. Persistent dyslipidemia in Austrian patients treated with statins for primary and secondary prevention of atherosclerotic events: results of the dyslipidemia international study (DYSIS). Wien Klin Wochenschr 2011 Oct; 123(19–20): 611–617.
González-Juanatey JR, Millán J, Alegría E, et al. Prevalence and characteristics of lipid abnormalities in patients treated with statins in primary and secondary prevention in Spain: DYSIS-Spain Study [in Spanish]. Rev Esp Cardiol 2011 Apr. 64 (4): 286–94.
Horgan S, Crowley J, Feely J, et al. Prevalence of dyslipidaemia in statintreated patients in Ireland: Irish results of the DYSlipidaemia International Study (DYSIS). Ir J Med Sci 2011 Jun. 180 (2): 343–9.
Gitt AK, Jünger C, Smolka W, et al. Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany. Clin Res Cardiol 2010 Nov. 99 (11): 723–33.
Strang AC, Kaasjager HA, Basart DC, et al. Prevalence of dyslipidaemia in patients treated with lipid-modifying drugs in the Netherlands: part of the dyslipidaemia international survey. Neth J Med 2010 Apr. 68 (4): 168–74.
Goodman SG, Langer A, Bastien NR, et al. Prevalence of dyslipidemia in statin-treated patients in Canada: results of the DYSlipidemia International Study (DYSIS). Can J Cardiol 2010 Nov; 26(9): e330–5.
Leiter LA, Lundman P, da Silva PM, et al. Persistent lipid abnormalities in statin-treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study. Diabet Med 2011 Nov. 28 (11): 1343–51.
Musunuru K, Blumenthal RS. The implications of the ezetimibe and simvastatin in hypercholesterolemia enhances atherosclerosis regression trial: a return to first principles. Clin Cardiol 2008 Jun. 31 (6): 288–90.
Khanderia U, Regal RE, Rubenfire M, et al. The ezetimibe controversy: implications for clinical practice. Ther Adv Cardiovasc Dis 2011 Aug. 5 (4): 199–208.
Vytorin tablets: summary of product characteristics [in Portuguese]. Trofa, Portugal: BIAL-Portela & Co., SA, 2011 Apr 11.
Goltor tablets: summary of product characteristics [in Italian]. Rome: Sigma-Tau Industrie Farmaceutiche Riunite S.p.A., 2011.
Inegy tablets: UK summary of product characteristics. Hoddesdon; MSD-SP Ltd, 2011 Jul 28.
Vytorin (ezetimibe/simvastatin) tablets: US prescribing information. North Wales (PA): Merck/Schering-Plough Pharmaceuticals, 2011 Jun.
Kamat SA, Bullano MF, Chang CL, et al. Adherence to single-pill combination versus multiple-pill combination lipid-modifying therapy among patients with mixed dyslipidemia in a managed care population. Curr Med Res Opin 2011 May. 27 (5): 961–8.
Jia L, Betters JL, Yu Li. Niemann-Pick C1-Like 1 (NPC1L1) protein in intestinal and hepatic cholesterol transport. Annu Rev Physio 2011 Mar 17. 73: 239–59.
Davidson MH, McGarry T, Bettis R, et al. Ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia. J Am Coll Cardiol 2002 Dec 18. 40 (12): 2125–34.
Goldberg AC, Sapre A, Liu J, et al. Efficacy and safety of ezetimibe coadministered with simvastatin in patients with primary hypercholesterolemia: a randomized, double-blind, placebo-controlled trial. Mayo Clinic Proc 2004; 79: 620–9.
Bays HE, Ose L, Fraser N, et al. A multicenter, randomized, double-blind, placebo-controlled, factorial design study to evaluate the lipid-altering efficacy and safety profile of the ezetimibe/simvastatin tablet compared with ezetimibe and simvastatin monotherapy in patients with primary hypercholesterolemia. Clin Ther 2004 Nov. 6 (11): 1758–73.
Feldman T, Koren M, Insull Jr W, 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): 1481–6.
Masana L, Mata P, Gagné C, et al. Long-term safety and, tolerability profiles and lipid-modifying efficacy of ezetimibe coadministered with ongoing simvastatin treatment: a multicenter, randomized, double-blind, placebocontrolled, 48-week extension study. Clin Ther 2005 Feb. 27 (2): 174–84.
Leiter LA, Betteridge DJ, Farnier M, et al. Lipid-altering efficacy and safety profile of combination therapy with ezetimibe/statin vs. statin monotherapy in patients with and without diabetes: an analysis of pooled data from 27 clinical trials. Diabetes Obes Metab 2011 Jul. 13 (7): 615–28.
Ballantyne CM, Blazing MA, King TR, et al. Efficacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia. Am J Cardiol 2004 Jun 15. 93 (12): 1487–94.
Farnier M, Averna M, Missault L, et al. Lipid-altering efficacy of ezetimibe/simvastatin 10/20mg compared with rosuvastatin 10mg in high-risk hypercholesterolaemic patients inadequately controlled with prior statin monotherapy: the IN-CROSS study. Int J Clin Pract 2009 Apr; 63(4): 547–559.
Mikhailidis DP, Lawson RW, McCormick AL, et al. Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. Curr Med Res Opin 2011 Jun. 27 (6): 1191–210.
Averna M, Zaninelli A, Le Grazie C, et al. Ezetimibe/simvastatin 10/20mg versus simvastatin 40mg in coronary heart disease patients. J Clin Lipidol 2010 Jul–Aug; 4(4):272–8.
Gaudiani L, Lewin A, Meneghini L, et al. Efficacy and safety of ezetimibe coadministered with simvastatin in thiazolidinedione-treated type 2 diabetic patients. Diabetes Obes Metab 2005 Jan. 7 (1): 88–97.
Bardini G, Giorda CB, Pontiroli AE, et al. Ezetimibe+simvastatin versus doubling the dose of simvastatin in high cardiovascular risk diabetics: a multicenter, randomized trial (the LEAD study). Cardiovasc Diabetol 2010 May 21; 9: 20.
Baigent C, Landray MJ, Reith C, et al. The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011 Jun 25. 377 (9784): 2181–92.
Kastelein JJP, Akdim F, Stroes ESG, et al. Simvastatin with or with ezetimibe in familial hypercholesterolemia. N Eng J Med 2008 Apr 3. 358 (14): 1431–43.
Meaney A, Ceballos G, Asbun J, et al. The VYtorin on Carotid intima-media thickness and overall arterial rigidity (VYCTOR) study. J Clin Pharmacol 2009 Jul. 49 (7): 838–47.
Avellone G, Di Garbo V, Guarnotta V, et al. Efficacy and safety of long-term ezetimibe/simvastatin treatment in patients with familial hypercholesterolemia. Int Angiol 2010 Dec. 29 (6): 514–24.
Simon A, Gariepy J, Chironi G, et al. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002 Feb. 20 (2): 159–69.
Florentin M, Liberopoulos EN, Moutzouri E, et al. The effect of simvastatin alone versus simvastatin plus ezetimibe on the concentration of small dense low-density lipoprotein cholesterol in subjects with primary hypercholesterolemia. Curr Med Res Opin 2011 Mar. 27 (3): 685–92.
Winkler K, Jacob S, Müller-Schewe T, et al. Ezetimibe alone and in combination lowers the concentration of small, dense low-density lipoproteins in type 2 diabetes mellitus. Atherosclerosis. Epub 2011 Nov 9.
Rossebø AB, Pedersen TR, Boman K, et al. Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis. N Engl J Med 2008 Sep 25. 359 (13): 1343–56.
Cannon CP, Giugliano RP, Blazing MA, et al. Rationale and design of IMPROVE-IT (IMProved Reduction of Outcomes: Vytorin Efficacy International Trial): comparison of ezetimbe/simvastatin versus simvastatin monotherapy on cardiovascular outcomes in patients with acute coronary syndromes. Am Heart J 2008 Nov. 156 (5): 826–32.
McCormack T, Harvey P, Gaunt R, et al. Incremental cholesterol reduction with ezetimibe/simvastatin, atorvastatin and rosuvastatin in UK General Practice (IN-PRACTICE): randomised controlled trial of achievement of Joint British Societies (JBS-2) cholesterol targets. Int J Clin Pract 2010 Jul. 64 (8): 1052–61.
Friedman HS, Rajagopalan S, Barnes JP, et al. Combination therapy with ezetimibe/simvastatin versus statin monotherapy for low-density lipoprotein cholesterol reduction and goal attainment in a real-world clinical setting. Clin Ther 2011 Feb. 33 (2): 212–24.
Lee YH, Kim MJ, Choi CI, et al. Retrospective study on antihyperlipidemic efficacy and safety of simvastatin, ezetimibe and their combination in Korean adults. Arch Pharm Res 2011 Aug. 34 (8): 1331–7.
Furman A, Meier JL, Malmstrom RA, et al. Comparative efficacy of ezetimibe/simvastatin, rosuvastatin, and atorvastatin in uncontrolled hyperlipidemia patients. Am J Manag Care 2011; 17 (8): 538–44.
Kashani A, Sallam T, Bheemreddy S, et al. Review of side-effect profile of combination ezetimibe and statin therapy in randomized clinical trials. Am J Cardiol 2008 Jun 1. 101 (11): 1606–13.
Peto R, Emberson J, Landray M, et al. Analyses of cancer data from three ezetimibe trials. N Engl J Med 2008 Sep 25. 359 (13): 1357–66.
Acknowledgments and Disclosures
This article was reviewed by: M. Averna, Department of Clinical Medicine and Emerging Diseases, University of Palermo Medical School, Palermo, Italy; W.H. Frishman, Department of Medicine, New York Medical College, Valhalla, NY, USA; S. Saluja, Consultant in Internal Medicine, Saran Ashram, Agra, India.
The preparation of this article was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on the articles. Changes resulting from comments received were made by the authors on the basis of scientific and editorial merit.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lyseng-Williamson, K.A. Ezetimibe/Simvastatin: A Guide to its Clinical Use in Hypercholesterolemia. Am J Cardiovasc Drugs 12, 49–56 (2012). https://doi.org/10.2165/11209150-000000000-00000
Published:
Issue Date:
DOI: https://doi.org/10.2165/11209150-000000000-00000