Pleiotropic effects of ezetimibe/simvastatin vs. high dose simvastatin

Antonio Eduardo P Pesaro, Carlos V. Serrano, Juliano L. Fernandes, Alexandre B. Cavalcanti, Alexandre H. Campos, Herlon S. Martins, Raul C. Maranhão, James A de Lemos, Heraldo P. Souza, José C. Nicolau

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29 Scopus citations


Background: In the setting of stable coronary artery disease (CAD), it is not known if the pleiotropic effects of cholesterol reduction differ between combined ezetimibe/simvastatin and high-dose simvastatin alone. Objective: We sought to compare the anti-inflammatory and antiplatelet effects of ezetimibe 10 mg/simvastatin 20 mg (E10/S20) with simvastatin 80 mg (S80). Methods and results: CAD patients (n = 83, 63 ± 9 years, 57% men) receiving S20, were randomly allocated to receive E10/S20 or S80, for 6 weeks. Lipids, inflammatory markers (C-reactive protein, interleukin-6, monocyte chemoattractant protein-1, soluble CD40 ligand and oxidized LDL), and platelet aggregation (platelet function analyzer [PFA]-100) changes were determined. Baseline lipids, inflammatory markers and PFA-100 were similar between groups. After treatment, E10/S20 and S80 patients presented, respectively: (1) similar reduction in LDL-C (29 ± 13% vs. 28 ± 30%, p = 0.46), apo-B (18 ± 17% vs. 22 ± 15%, p = 0.22) and oxidized LDL (15 ± 33% vs. 18 ± 47%, p = 0.30); (2) no changes in inflammatory markers; and, (3) a higher increase of the PFA-100 with E10/S20 than with S80 (27 ± 43% vs. 8 ± 33%, p = 0.02). Conclusions: These data suggest that among stable CAD patients treated with S20, (1) both E10/S20 and S80 were equally effective in further reducing LDL-C; (2) neither treatment had any further significant anti-inflammatory effects; and (3) E10/S20 was more effective than S80 in inhibiting platelet aggregation. Thus, despite similar lipid lowering and doses 4× less of simvastatin, E10/S20 induced a greater platelet inhibitory effect than S80.

Original languageEnglish (US)
Pages (from-to)400-404
Number of pages5
JournalInternational Journal of Cardiology
Issue number3
StatePublished - Jul 26 2012


  • Cholesterol
  • Coronary artery disease
  • Inflammation
  • Platelet function
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Pesaro, A. E. P., Serrano, C. V., Fernandes, J. L., Cavalcanti, A. B., Campos, A. H., Martins, H. S., Maranhão, R. C., de Lemos, J. A., Souza, H. P., & Nicolau, J. C. (2012). Pleiotropic effects of ezetimibe/simvastatin vs. high dose simvastatin. International Journal of Cardiology, 158(3), 400-404.