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Am J Cardiol. 2018 Oct 19. pii: S0002-9149(18)31970-2. doi: 10.1016/j.amjcard.2018.09.041. [Epub ahead of print]

Usefulness of Low-Dose Statin Plus Ezetimibe and/or Nutraceuticals in Patients With Coronary Artery Disease Intolerant to High-Dose Statin Treatment.

Author information

1
Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy. Electronic address: giuseppe.marazzi@sanraffaele.it.
2
Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy.
3
University of Rome "la Sapienza", Rome, Italy.
4
University of Campania, Caserta, Italy.
5
Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
6
Instituto di Ricerca a Carattere Scientifico (IRCCS) San Raffaele, Rome, Italy; St George's Hospital NHS Trust Medical School, London, United Kingdom.

Abstract

High-dose statin (HDS) therapy is recommended to reduce low-density lipoprotein cholesterol (LDL-C); however, some patients are unable to tolerate the associated side effects. Nutraceuticals have shown efficacy in lowering LDL-C. The aim of this study was to evaluate whether the combination of low-dose statin (LDS) plus ezetimibe (EZE) or LDS plus nutraceutical (Armolipid Plus [ALP] containing red yeast rice, policosanol, and berberine) can lead to a higher proportion of high-risk patients achieving target LDL-C. A secondary objective was to assess the efficacy of triple combination LDS + EZE + ALP in resistant patients (LDL-C >70 mg/dl). A randomized, prospective, parallel-group, single-blind study was conducted in patients with coronary artery disease (n = 100) who had undergone percutaneous coronary intervention in the preceding 12 months, were HDS-intolerant, and were not at LDL-C target (<70 mg/dl) with LDS alone. Patients received either LDS + EZE or LDS + ALP. Of the 100 patients, 33 patients (66%) treated with LDS + EZE and 31 patients (62%) treated with LDS + ALP achieved target LDL-C after 3 months, which was maintained at 6 months. Patients who did not achieve the therapeutic goal received a triple combination of LDS + EZE + ALP for a further 3 months. At 6 months, 28 of 36 patients (78%) achieved LDL-C target. Overall, 92% of patients enrolled in this study were at target LDL-C at 6 months. No patients in any group experienced major side effects. In conclusion, in HDS-intolerant coronary artery disease patients, the combination of LDS plus EZE and/or ALP represents a valuable therapeutic option allowing most patients to reach target LDL-C within 3 to 6 months.

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