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Correspondence: Christian Constance, Hopital Maisonneuve-Rosemont Recherche Clinique/Polyclinique, 5415 Boulevard de l’Assomption, Suite 295, H1T 2 M4 Montreal, QC, Canada; Email: constancec@videotron.ca

Authors' Contributions: Each of the authors fulfilled the ICMJE authorship criteria.

They all contributed to the design of the study, collected or assembled the data, performed or supervised analyses, and/or interpreted the results; wrote sections of the initial draft and/or provided substantive suggestions for revisions on subsequent iterations of the manuscript.

In addition, all authors had access to study data and approved the final version of this article.

Acknowledgments: Editorial assistance was provided by Jennifer Rotonda, PhD, of Merck & Co, Inc., Whitehouse Station, NJ, USA.

Disclosures: CC reports receiving personal fees from lectures not related to the submitted work.

OBY and FZ report no conflicts of interest.

NKW reports work with the Abbott Women’s Advisory Board.

JL, MEH, RSL and AMT are employees of Merck & Co., Inc. and may own stock or hold stock options in the company.

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Research Funding:

This work was funded by Merck & Co., Inc, Whitehouse Station, NJ.

NKW reports grants from Abbott, Amgen, AstraZeneca, Gilead Sciences, Janssen Pharmaceuticals, Merck, NHLBI, and Pfizer

Atorvastatin 10 mg plus ezetimibe versus titration to atorvastatin 40 mg: attainment of European and Canadian guideline lipid targets in high-risk subjects ≥65 years

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Journal Title:

Lipids in Health and Disease

Volume:

Volume 13, Number 13

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Article | Final Publisher PDF

Abstract:

Background Few clinical studies have focused on the efficacy of lipid-lowering therapies in patients ≥65 years. Methods After stabilization on atorvastatin 10 mg, hypercholesterolemic subjects ≥65 years at high/very high risk for CHD and not at LDL-C <1.81 mmol/L (with atherosclerotic vascular disease [AVD]) or <2.59 mmol/L (without AVD) were randomized to ezetimibe 10 mg plus atorvastatin 10 mg or uptitration to atorvastatin 20 mg (6 weeks) followed by uptitration to 40 mg (additional 6 weeks). A post-hoc analysis compared between-group differences in percent attainment of individual and combined LDL-C, non-HDL-C and Apo B targets based on recommendations from 2012 European and Canadian Cardiovascular Society (CCS) guidelines for dyslipidemia treatment. Results Atorvastatin 10 mg plus ezetimibe produced significantly greater attainment of LDL-C, non-HDL-C, and Apo B individual and dual/triple targets vs. atorvastatin 20 mg for the entire cohort and very high-risk groups at 6 weeks. After 12 weeks, very high-risk subjects maintained significantly greater achievement of LDL-C <1.8 mmol/L (47% vs. 35%), non-HDL-C <2.6 mmol/L (63% vs. 53%) and Apo B <0.8 g/L (47% vs. 38%) single targets and dual/triple targets with atorvastatin 10 mg plus ezetimibe vs. atorvastatin 40 mg, while attainment of European target for high-risk subjects was generally similar for both treatments. Achievement of Canadian targets was significantly greater with combination therapy vs. atorvastatin 20 mg (6 weeks) or atorvastatin 40 mg (12 weeks). Conclusions Atorvastatin 10 mg plus ezetimibe provided more effective treatment than uptitration to atorvastatin 20/40 mg for attainment of most European and Canadian guideline-recommended lipid targets in older at-risk patients. Trial registration ClinicalTrials.gov identifier NCT00418834. Keywords: Ezetimibe; Atorvastatin; Hyperlipidemia; Elderly; Statin; Combination therapy

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© 2014 Constance et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Universal : Public Domain Dedication License (http://creativecommons.org/publicdomain/zero/1.0/).

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