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Has anyone here combined ezetimibe and rosuvastatin? Dr Brewer, your opinion please.

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  • Has anyone here combined ezetimibe and rosuvastatin? Dr Brewer, your opinion please.

    I ask this because an RCT showed significant improvement in inflammation markers when both were taken in combination:

    Comparison of the effect of rosuvastatin versus rosuvastatin/ezetimibe on markers of inflammation in patients with acute myocardial infarction

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5704334/

    In particular, the Lp-PLA2 dropped significantly more when with the combination:
    "The addition of ezetimibe to rosuvastatin led to greater reduction of LDL-C compared with rosuvastatin monotherapy (from 3.00 to 1.19 mmol/l vs. 2.93 to 1.49 mmol/l, respectively; P<0.05), as well as reduced levels of hs-CRP (from 5.15 to 0.68 mg/l vs. 4.33 to 1.49 mg/l, respectively; P<0.05) and Lp-PLA2 (from 333.13 to 79.07 mg/l vs. 327.95 to 123.62 mg/l, respectively; P<0.05)."

    I am currently taking rosuvastatin monotherapy but if I can further decrease the Lp-PLA2 with the addition of 10mg of ezetimibe (Zetia) then I'll try to get one of my GPs to prescribe it.

    I would like to take pitavastatin rather than rosuvastatin but the commercial price is very high. Canadian pharmacies sell a much cheaper generic version, but I think it is manufactured in India, and Indian generic drugs have quality control problems. Also, I doubt the ignoramuses at the VA would be willing to prescribe it for me even though it is in the VA formulary. They still think that the purpose of statins is to reduce LDL-C, not inflammation.

  • #2
    The study was limited (or not powered sufficiently as researchers would say) to make a definitive conclusion. The below statement sort of sums it up: "Although the addition of ezetimibe to rosuvastatin resulted in a greater reduction of Lp-PLA2, the difference between the monotherapy and combination treatment did not achieve statistical significance in prespecified subgroups".

    I have heard that some lipidologists favor a low dose statin with ezetimibe as an excellent alternative to a high dose statin. I would take the combination myself.

    If you don't hear back from Dr. Brewer on this topic, mention it in the comments section of one of his videos as I think he monitors those more frequently.

    Comment


    • fatmax
      fatmax commented
      Editing a comment
      It achieved statistical significance with the entire population of 113 patients.

  • #3
    The JUPITER trial showed about a 33% reduction in Lp-PLA2 in one year for patients taking 20mg rosuvastatin monotherapy and about 12% reduction for those taking the placebo:
    http://clinchem.aaccjnls.org/content...80281.full.pdf

    If the results in the Chinese combo trial are credible, they showed a 76% reduction in Lp-PLA2 in one year for those taking the 10/10 dual therapy and a 62% reduction for the 10mg rosuvastatin monotherapy. However, the patient population here had had a recent heart attack and must have had massive inflammation as well, unlike in the JUPITER trial which was composed of 17,802 men and women without cardiovascular disease or diabetes at study entry.

    In 9 months of taking 20mg rosuvastatin, my Lp-PLA2 has decreased by 20%. If no further reduction is shown by September then I'm going to switch to 10/10.

    Comment


    • #4
      I'm late to the party, but I'm on rosuvastatin-20 + ezetimibe. Drives LDL-P into the floor. So much so that I've been half dosing the ezetimibe. I think how efficacious it is depends on your diet and genetics as well though.

      Comment


      • fatmax
        fatmax commented
        Editing a comment
        Can you provide some inflammation numbers, please? What are your LDL-P, LDL-small, and LDL-medium numbers? What is your LP-PLA2? How have these values changed over time? Have you had a CAC scan?
        Thanks.
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