Effects of Simvastatin and Ezetimibe on Cardiovascular Risk Markers in Patients With Dyslipidemia
6 februari 2018 bijgewerkt door: Antonio Hernandez Mijares, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana
Study of Lipoprotein Subfractions, Inflammation, Oxidative Stress and Endothelial Function After Treatment With Simvastatin and Ezetimibe Administered Alone and in Combination in Hyperlipidemic Patients
Coadministration of drugs is common in the pharmacologic treatment of dyslipidemia, with statins and ezetimibe generally constituting the medication of choice.
By acting at different levels, the combination of these drugs allows the therapeutic objective to be achieved.
However, it is not known how these drugs qualitatively affect the composition of lipoprotein subfractions, which differ in size and atherogenic potential.
The investigators set out to evaluate this effect as well as their effects on inflammatory, oxidative stress and endothelial function parameters.
Studie Overzicht
Toestand
Voltooid
Conditie
Interventie / Behandeling
Gedetailleerde beschrijving
The study consisted of a randomised parallel trial and took place during a period of 2 months.
A total of 42 hyperlipidemic patients were randomly assigned to one of 2 groups: one received simvastatin (40 mg/day) and the other received ezetimibe (10 mg/day) for 4 weeks, after which both groups were administered combined therapy for an additional 4-week period.
Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.
Studietype
Ingrijpend
Inschrijving (Werkelijk)
42
Fase
- Niet toepasbaar
Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
18 jaar en ouder (Volwassen, Oudere volwassene)
Accepteert gezonde vrijwilligers
Nee
Geslachten die in aanmerking komen voor studie
Allemaal
Beschrijving
Inclusion Criteria:
- LDL cholesterol concentration of between 160-190 mg/dl in patients with less than 2 cardiovascular risk factors
- LDL concentration of between 130-160 mg/dl in patients that presented 2 or more cardiovascular risk factors.
Cardiovascular risk factors were defined as: age (≥ 45 years in men and ≥55 years in women), a smoking habit, hypertension (≥140/90 mmHg), diabetes mellitus, a high-density lipoprotein (HDL) cholesterol concentration of ≤ 40mg/dl, and a family history of cardiovascular disease.
Exclusion Criteria:
- Triglyceride concentration > 400 mg/dl
- Diabetes Mellitus
- Kidney, liver, or thyroid disease
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Behandeling
- Toewijzing: Gerandomiseerd
- Interventioneel model: Parallelle opdracht
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Simvastatin
Hyperlipidemic patients received simvastatin (40 mg/day) for 4 weeks, after they were administered combined therapy (simvastatin, 40 mg/day plus ezetimibe,10 mg/day) for an additional 4-week period.
Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.
|
simvastatin (40 mg/day) for 4 weeks
combined therapy simvastatin (40 mg/day) + ezetimibe (10 mg/day) for 4-week period
|
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Experimenteel: Ezetimibe
Hyperlipidemic patients received ezetimibe (10 mg/day) for 4 weeks, after they were administered combined therapy (simvastatin, 40 mg/day plus ezetimibe,10 mg/day) for an additional 4-week period.
Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.
|
combined therapy simvastatin (40 mg/day) + ezetimibe (10 mg/day) for 4-week period
ezetimibe (10 mg/day) for 4 weeks
|
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Total Cholesterol Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Total cholesterol concentration was measured by enzymatic assay
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Baseline, 4 weeks and 8 weeks
|
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Low-density Lipoprotein Cholesterol (LDLc) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Low-density lipoprotein cholesterol (LDLc) concentration was calculated using the method of Friedewald.
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Baseline, 4 weeks and 8 weeks
|
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High-density Lipoprotein Cholesterol (HDLc) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
High-density lipoprotein cholesterol (HDLc) concentration was measured using a direct method
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Baseline, 4 weeks and 8 weeks
|
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Triglycerides Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Triglyceride concentration were measured by enzymatic assay
|
Baseline, 4 weeks and 8 weeks
|
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Non-HDL Cholesterol Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Non-HDLc concentration was obtained by calculating the difference between total cholesterol and HDLc
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Baseline, 4 weeks and 8 weeks
|
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Low Density Lipoprotein Size Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
LDL subfractions were separated by high-resolution polyacrylamide gel tubes using the Lipoprint® system.
The LDL electrophoretic profile allows 2 patterns to be defined: pattern A or large and buoyant LDL, and pattern non-A or small and dense LDL.
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Baseline, 4 weeks and 8 weeks
|
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Apolipoprotein B Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Levels of apolipoprotein B were determined by inmunonephelometry
|
Baseline, 4 weeks and 8 weeks
|
Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
|
Levels of High-sensitive C-reactive Protein (hsCRP) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Levels of high-sensitive C-reactive protein (hsCRP) were analysed by a latex-enhanced inmunonephelometric assay
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Baseline, 4 weeks and 8 weeks
|
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Levels of Interleukin-6 (IL-6) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Levels of proinflammatory cytokines (interleukin-6 (IL-6)) were analysed with a Luminex® 200™ system
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Baseline, 4 weeks and 8 weeks
|
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Levels of Tumor Necrosis Factor α (TNF-α) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Levels of proinflammatory cytokines (tumor necrosis factor α (TNF-α)) were analysed with a Luminex® 200™ system
|
Baseline, 4 weeks and 8 weeks
|
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Mitochondrial Oxygen (O2) Consumption Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Oxidative stress markers (mitochondrial oxygen (O2) consumption) was measured at baseline and after treatment by Clark electrode
|
Baseline, 4 weeks and 8 weeks
|
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Reactive Oxygen Species (ROS) Production Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Oxidative stress markers (Reactive oxygen species (ROS) production) was measured at baseline and after treatment by fluorometric techniques
|
Baseline, 4 weeks and 8 weeks
|
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Membrane Potential Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Oxidative stress markers (membrane potential) was measured at baseline and after treatment by fluorometric techniques
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Baseline, 4 weeks and 8 weeks
|
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Levels of Glutathione (GSH) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Oxidative stress markers (levels of glutathione (GSH)) was measured at baseline and after treatment by fluorometric techniques
|
Baseline, 4 weeks and 8 weeks
|
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Leukocyte Rolling Flux Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy.
Leukocyte rolling was estimated as the number of leukocytes rolling over 100 μm2 of the endothelial monolayer during a 1-min period.
|
Baseline, 4 weeks and 8 weeks
|
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Leukocyte Adhesion Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy.
Adhesion was evaluated by counting the number of polymorphonuclear cells that maintained stable contact with human umbilical vein endothelial cells (HUVEC) for 30 seconds.
|
Baseline, 4 weeks and 8 weeks
|
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Leukocyte Rolling Velocity Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy.The rolling velocity in the field of focus was determined by measuring the time required by 20 consecutive leukocytes to cover a distance of 100 μm.
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Baseline, 4 weeks and 8 weeks
|
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Levels of Vascular Cell Adhesion Molecule 1 (VCAM-1) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
The vascular cell adhesion molecule 1 (VCAM-1) was evaluated in serum by Luminex® 200™ system
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Baseline, 4 weeks and 8 weeks
|
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Levels of Intercellular Adhesion Molecule 1 (ICAM-1) Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
The intercellular adhesion molecule 1 (ICAM-1) was evaluated in serum by Luminex® 200™ system
|
Baseline, 4 weeks and 8 weeks
|
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Levels of E-selectin Before and After Simvastatin/Ezetimibe Administration
Tijdsspanne: Baseline, 4 weeks and 8 weeks
|
E-selectin was evaluated in serum by Luminex® 200™ system
|
Baseline, 4 weeks and 8 weeks
|
Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Sponsor
Onderzoekers
- Hoofdonderzoeker: Antonio Hernández, MD, Phd, FISABIO - University Hospital Dr Peset
Publicaties en nuttige links
De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.
Algemene publicaties
- Berneis K, Rizzo M, Berthold HK, Spinas GA, Krone W, Gouni-Berthold I. Ezetimibe alone or in combination with simvastatin increases small dense low-density lipoproteins in healthy men: a randomized trial. Eur Heart J. 2010 Jul;31(13):1633-9. doi: 10.1093/eurheartj/ehq181. Epub 2010 Jun 6.
- Florentin M, Liberopoulos EN, Moutzouri E, Rizos CV, Tselepis AD, Elisaf MS. 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. doi: 10.1185/03007995.2010.546394. Epub 2011 Jan 27.
- Bays HE, Ose L, Fraser N, Tribble DL, Quinto K, Reyes R, Johnson-Levonas AO, Sapre A, Donahue SR; Ezetimibe Study Group. 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;26(11):1758-73. doi: 10.1016/j.clinthera.2004.11.016.
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start
1 januari 2009
Primaire voltooiing (Werkelijk)
1 december 2011
Studie voltooiing (Werkelijk)
1 december 2011
Studieregistratiedata
Eerst ingediend
25 november 2014
Eerst ingediend dat voldeed aan de QC-criteria
26 november 2014
Eerst geplaatst (Schatting)
2 december 2014
Updates van studierecords
Laatste update geplaatst (Werkelijk)
8 maart 2018
Laatste update ingediend die voldeed aan QC-criteria
6 februari 2018
Laatst geverifieerd
1 februari 2018
Meer informatie
Termen gerelateerd aan deze studie
Trefwoorden
Aanvullende relevante MeSH-voorwaarden
- Metabole ziekten
- Stoornissen in het metabolisme van lipiden
- Dyslipidemie
- Moleculaire mechanismen van farmacologische werking
- Enzymremmers
- Antimetabolieten
- Middelen tegen cholesterol
- Hypolipidemische middelen
- Vetregulerende middelen
- Hydroxymethylglutaryl-CoA-reductaseremmers
- Simvastatine
- Ezetimibe
- Ezetimibe, combinatie van geneesmiddelen met simvastatine
Andere studie-ID-nummers
- SIM-EZE-2009-01
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .