Effect of Ezetimibe and Simvastatin Therapy in Subjects with Hyperlipidemia on Ankle Brachial Index, High Sensitive C Reactive Protein and Carotid Intima Media Thickness

INTRODUCTION: Atherosclerosis is the leading cause of mortality and morbidity. Statins alleviate the atherosclerotic process, as these drugs have been shown to decrease serum levels of C-reactive protein. Ezetimibe is another hypolipidemic drug. The ankle-brachial index (ABI) is a non-invasive method of diagnosing peripheral arterial disease, and carotid intima-media thickness (CIMT) is a measure of subclinical atherosclerosis. We sought to evaluate the effect of ezetimibe, simvastatin, and their combination on lipid parameters, ABI, and CIMT.
METHODS: Sixty patients without a history of atherosclerotic vascular disease were included in this study. Patients were divided into three groups: the first group received 10 mg/day ezetimibe, the second group received 20 mg/day simvastatin, and the third group received a combination of 20 mg/day simvastatin and 10 mg/day ezetimibe. Baseline cholesterol levels, creatine kinase, alanine aminotransferase, aspartate aminotransferase, hsCRP levels, ABI, and CIMT were measured. Blood tests were repeated at the 6th week, and all baseline measurements were performed at the end of the 3rd month.
RESULTS: All groups exhibited a significant decrease in total and LDL cholesterol levels at the end of the 6th week. There was a significant decrease in hsCRP levels in the simvastatin-only and simvastatin-ezetimibe combination groups. The ABI increased significantly in the ezetimibe-simvastatin combination group but not in the others. No change in CIMT was noted in any group.
DISCUSSION AND CONCLUSION: The cholesterol profile improved in all groups. The hsCRP levels decreased significantly in the simvastatin and combination groups but not in the ezetimibe-only group, possibly due to ezetimibe lacking pleiotropic effects. The ABI values improved in the combination group, likely due to ezetimibe potentiating the positive effects of simvastatin on the endothelium. There was no change in CIMT in any group, probably due to the short follow-up period and small sample size.