Effect of ezetimibe monotherapy on the concentration of lipoprotein subfractions in patients with primary dyslipidaemia

Abstract

Ezetimibe can favourably affect the distribution of LDL subfractions, especially in patients with elevated triglyceride values. Further studies are needed to clarify the significance of the ezetimibe-induced reduction in the concentrations of dense HDL particles.

Ezetimibe: cholesterol lowering and beyond

“…In a recent study of patients with primary dyslipidemias, ezetimibe reduced the concentration of all LDL subfractions (tube gel, Lipoprint), with significant increases in the reduction of small, dense LDL particles and a shift toward larger and less atherogenic LDL particles, especially in patients with hypertriglyceridemia (TG > 200 mg/dl) [118]. Similarly, ezetimibe coadministered with fenofibrate produced greater reductions in lipoprotein subfractions (VAP), in addition to a preferential loss in small, dense LDL particles (S 3 GGE), compared with fenofibrate alone [115], although this was largely attributed to the TG-lowering effect of fenofibrate.…”

“…Because the size of TRL pools are related to lipid subfraction patterns [118,119], similar to statins, the ezetimibe effect on particle size will be most pronounced in hypertriglyceridemic patients. In a recent study of patients with primary dyslipidemias, ezetimibe reduced the concentration of all LDL subfractions (tube gel, Lipoprint), with significant increases in the reduction of small, dense LDL particles and a shift toward larger and less atherogenic LDL particles, especially in patients with hypertriglyceridemia (TG > 200 mg/dl) [118].…”

The importance of treating multiple cardiometabolic risk factors in patients with Type 2 diabetes

“…A recent meta-analysis involving 5039 patients where ezetimibe was added to a statin showed a decrease of 10.7% in triglyceride levels and a rise in HDL-C levels of 1.7% [60] . There is also evidence that ezetimibe can lower triglyceride levels to a greater extent when baseline values are 'high' [61] , and in these patients, small, dense LDL may be preferentially decreased [62] .…”

Clinical benefits of ezetimibe use: is absence of proof, proof of absence?

“…More controversial findings associated with ezetimibe include the potential increase in the proportion of small, dense (sd) LDL particles [11,12]. Nevertheless, this remains an ongoing debate [13][14][15].…”