Abstract
Lee at al 1 report that atorvastatin + ezetimibe (5 + 5 mg/d) combination was more effective than atorvastatin (20 mg/d) monotherapy in lowering fasting and postprandial triglyceride (TG) levels. Some comments regarding this may be of interest.
Ezetimibe can enhance the hypotriglyceridemic effect of statins. In a meta-analysis (5039 patients), ezetimibe 10 mg/d on top of statin treatment was associated with an additional decrease in TG levels by 10.7% (P < .0001). 2 According to our experience, the TG-lowering effect of ezetimibe is positively correlated with the baseline TG levels. 3,4 Therefore, we would like to know whether in the Lee et al study, 1 TG lowering was greater in the upper tertile of TG values than that in the lower ones.
Raised TG levels are associated with a predominance of small dense low-density lipoprotein particles that are more atherogenic. 5 The cholesterol of these subfractions can be reduced by both statins and ezetimibe. 6 –8 Interestingly, TG levels appear to influence this effect. 6,7
The findings of Lee at al 1 are relevant because there is evidence that both fasting and postprandial TG levels predict vascular risk. 9