Making sense of ENHANCE: Ezetimibe (Zetia) lowers LDL cholesterol but doesn't decrease carotid intima-media thickness

2008 ◽  
Vol 75 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Donald Smith
Keyword(s):  
Ldl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness ◽  
Making Sense

scholarly journals Evaluation of Clinical Variables Associated with Increased Carotid Intima-Media Thickness in Middle-Aged Hypertensive Women

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Michelle Trindade ◽  
Renata Brum Martucci ◽  
Adriana K. Burlá ◽  
Wille Oigman ◽  
Mario Fritsch Neves ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pulse Pressure ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Independent Variables ◽  
Vascular Ultrasound ◽  
Media Thickness

It has been previously documented that carotid intima-media thickness (cIMT) is a predictor of cardiovascular disease. The aim of this study was to identify clinical parameters associated with an increased cIMT treated hypertensive women. Female patients (n=116) with essential hypertension, aged 40–65 years, were included in this study. Vascular ultrasound was performed and the patients were divided into two groups according to the values of cIMT (< or ≥0.9 mm). Patients with greater cIMT presented significantly higher systolic blood pressure and pulse pressure. Serum HDL-cholesterol was significantly lower and CRP was significantly higher in the same group. There was a significant correlation between cIMT and age (r=0.25,P=0.007), systolic blood pressure (r=0.19,P=0.009), pulse pressure (r=0.30,P=0.001), and LDL-cholesterol (r=0.19,P=0.043). cIMT was correlated to CRP (r=0.31,P=0.007) and negatively correlated to HDL-cholesterol (r=0.33,P=0.001). In logistic regression, only HDL-cholesterol, CRP, and pulse pressure were shown to be independent variables associated to increased cIMT. In conclusion, pulse pressure, HDL-cholesterol, and CRP are variables correlated with cIMT in treated hypertensive women.

Effects of magnesium supplementation on carotid intima–media thickness and metabolic profiles in diabetic haemodialysis patients: a randomised, double-blind, placebo-controlled trial

2019 ◽  
Vol 121 (7) ◽  
pp. 809-817 ◽  
Author(s):  
Hamid Reza Talari ◽  
Mehrafrouz Zakizade ◽  
Alireza Soleimani ◽  
Fereshteh Bahmani ◽  
Amir Ghaderi ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Ldl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Controlled Clinical Trial ◽  
Double Blind ◽  
Insulin Metabolism ◽  
Double Blind Placebo ◽  
Media Thickness ◽  
Hs Crp

AbstractThis study evaluated the effects of Mg administration on carotid intima–media thickness (CIMT), glycaemic control and markers of cardio-metabolic risk in diabetic haemodialysis (HD) patients. This randomised, double-blind, placebo-controlled clinical trial was conducted in fifty-four diabetic HD patients. Participants were randomly divided into two groups to take either 250 mg/d Mg as magnesium oxide (n27) or placebo (n27) for 24 weeks. Mg supplementation resulted in a significant reduction in mean (P<0·001) and maximum levels of left CIMT (P=0·02) and mean levels of right CIMT (P=0·004) compared with the placebo. In addition, taking Mg supplements significantly reduced serum insulin levels (β=–9·42 pmol/l; 95% CI –14·94, –3·90;P=0·001), homoeostasis model of assessment-insulin resistance (β=–0·56; 95 % CI –0·89, –0·24;P=0·001) and HbA1c (β=–0·74 %; 95 % CI –1·10, –0·39;P<0·001) and significantly increased the quantitative insulin sensitivity check index (β=0·008; 95 % CI 0·002, 0·01;P=0·002) compared with the placebo. In addition, Mg administration led to a significant reduction in serum total cholesterol (β=–0·30 mmol/l; 95% CI –0·56, –0·04;P=0·02), LDL-cholesterol (β=–0·29 mmol/l; 95% CI –0·52, –0·05;P=0·01), high-sensitivity C-reactive protein (hs-CRP) (P<0·001) and plasma malondialdehyde (MDA) (P=0·04) and a significant rise in plasma total antioxidant capacity (TAC) levels (P<0·001) compared with the placebo. Overall, we found that taking Mg for 24 weeks by diabetic HD patients significantly improved mean and maximum levels of left and mean levels of right CIMT, insulin metabolism, HbA1c, total cholesterol and LDL-cholesterol, hs-CRP, TAC and MDA levels.

scholarly journals Lower is better: ENHANCE affair

2016 ◽  
Vol 70 (2) ◽  
Author(s):  
Sabino Scardi ◽  
Paolo Umari ◽  
Bianca Maria D’Agata
Keyword(s):  
Carotid Arteries ◽  
Ldl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Pharmaceutical Companies ◽  
Atherosclerotic Plaques ◽  
American Government ◽  
Wall Street ◽  
Media Thickness ◽  
Scientific Associations

Ezetimibe lowers the intestinal absorption of cholesterol, being complementary to the effects of statin. To check its efficacy in lowering the carotid intima-media thickness, in 2002 a multicenter international trial called ENHANCE was started, in order to assess by ultrasound the regression of atherosclerotic plaques. The protocol tested the use of simvastatin 80 mg + placebo versus simvastatin 80 mg + ezetimibe 10 mg in 720 randomized patients. Both drugs were well tolerated. Combination therapy was associated with a larger reduction in LDL cholesterol, but there were no differences in the intima-media thickness measured at three sites in the carotid arteries, nor differences in cardiovascular events between the two groups in the trial. These results provoked disappointment of sponsors (Merck, Schering Plough) who, although the results of the trial were available since march 2007, delayed official communication of about 18 months. This led to speculations and rumors among media, American Government, cardiologic scientific associations, and consequences in the Ezetimibe market and at Wall Street. In particular, the American College of Cardiology didn’t accept the communication of ENHANCE results to the Late Breaking Trial Session of the Chicago congress, diverting it to another secondary forum. In conclusion, the experience of the ENHANCE trial suggests to pharmaceutical companies, researchers, clinicians, scientific companies and media a deep meditation in order to avoid in the future similar problems in the management of results of medical research.

Auto-antibodies against oxidized LDL as a marker of coronary artery disease in patients with familial hypercholesterolaemia

2000 ◽  
Vol 37 (2) ◽  
pp. 174-178 ◽  
Author(s):  
J E Paiker ◽  
F J Raal ◽  
M von Arb
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ldl Cholesterol ◽  
Familial Hypercholesterolaemia ◽  
Predictive Marker ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Media Thickness ◽  
Antibody Titres ◽  
Artery Disease

Auto-antibodies to oxidized low-density lipoprotein (ox-LDL) are thought to play a pivotal role in the pathogenesis of atherosclerosis. This study investigates the value of auto-antibodies to ox-LDL as a predictive marker of atherosclerosis in patients with both homozygous and heterozygous familial hypercholesterolaemia (FH), who are known to suffer from severe premature atherosclerosis. The influences of well-established risk factors for atherosclerosis such as age, LDL-cholesterol levels and smoking on the results were also determined. Auto-antibody titres to ox-LDL and fasting lipid profiles were measured in 26 homozygous FH patients, 20 heterozygous FH patients without documented coronary artery disease (CAD), 24 heterozygotes with overt CAD and 10 healthy normocholesterolaemic controls. Carotid intima-media thickness, used as an in vivo assessment of atherosclerosis, was also measured in the homozygous FH patients. Ox-LDL titres did not differ between the groups. There was also no association between ox-LDL titres and the LDL-cholesterol level ( P=0·14), presence or absence of CAD ( P=0·69), age ( P=0·50), carotid intima-media thickness ( P=0·51) or smoking ( P=1·0). In conclusion, antibody titres against ox-LDL cannot be used as a predictive marker of the presence or severity of atherosclerosis in patients with FH.

scholarly journals Oxidized LDL and C-reactive protein level in relation to carotid intima-media thickness in population with risk factors for atherosclerosis

2009 ◽  
Vol 137 (3-4) ◽  
pp. 140-145 ◽  
Author(s):  
Zorica Caparevic ◽  
Nada Kostic ◽  
Sanja Ilic ◽  
Jana Radojkovic ◽  
Djordje Marina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ldl Cholesterol ◽  
Oxidized Ldl ◽  
Positive Association ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Study Group ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Media Thickness

Introduction. Elevated levels of oxidized LDL cholesterol (OxLDL) are considered to be a key factor of initiating and accelerating atherosclerosis. It promotes atherosclerosis through inflammatory and immunologic mechanisms that lead to the formation of macrophage foam cells. Objective. To determine the relationship among OxLDL, C-reactive protein (CRP) level and carotid intima-media thickness (IMT) in population with risk factors for atherosclerosis. Methods. The study group consisted of 125 clinically healthy, hypercholesterolaemic subjects (49.3?5.7 years; 75 females and 50 males) compared with 100 age-matched population-based control subjects. The study group was divided into two subgroups: subgroup A (the levels of LDL cholesterol > 5 mmol/L) and subgroup B (the levels of LDL cholesterol <5 mmol/L). None of the subjects had history of cerebrovascular, ischaemic heart disease, hypertension or diabetes mellitus. Lipid profiles were measured by enzymatic methods. OxLDL was measured by using a specific monoclonal antibody, mAb4E6. CRP was measured using hemiluminescent methods (Immulite - DPC). The common carotid IMT was measured by the B-mode ultrasound. Results Compared to controls, the study group had higher levels of OxLDL (119.97?43.15 vs. 82.03?25.99 IU/L; p<0.01) and CRP (6.20?3.55 vs. 2.68?3.04 mg/ml; p<0.05). IMT was significantly higher in study subjects (1.14?0.38 vs. 0.72?0.24 mm; p<0.05). We also found that, in the whole study group, IMT significantly positively correlated with OxLDL (r=0.442; p<0.05). We found that in the study subgroup A, IMT positively correlated with CRP (r=0.792; p<0.01). In controls, we found a significantly positive association between IMT and OxLDL (r=0.781; p<0.01) and CRP (r=0.748; p<0.01). Conclusion. The elevated levels of OxLDL and CRP are associated with higher common carotid intima-media thickness in population with risk factors for atherosclerosis.

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