Vera-Lastra OL, Olvera-Acevedo A, Hernández C, Medina G, Carrillo-González AL, Ángeles-Garay U, Peralta-Amaro AL, Jara L

Language: Spanish
References: 29
Page: 74-79
PDF size: 149.24 Kb.

ABSTRACT

Introduction: Patients with systemic lupus erythematosus (SLE) have accelerated atherosclerosis that can be assessed by the carotid intima media thickness (CIMT) measurement. A prompt hypolipidemic treatment should be a part of the integral management. The aim of this study is to determine the effect of therapy with pravastatin plus ezetimibe on the CIMT in SLE patients.
Methods: Longitudinal, prospective, quasi-experimental trial. Out of 60 SLE patients in whom a carotid ultrasound was performed, we chose 22 with a CIMT › 0.7 mm who were administered pravastatin plus ezetimibe during 6 months with determination of CIMT at the end of the study. We performed the following tests: total cholesterol (TC), HDL-cholesterol, LDL-cholesterol, tryglicerides, C-reactive protein (CRP), liver function, muscle enzimes and glucose, basal and at the end of treatment. Statistical analysis: descriptive statistics and Wilcoxon test were used.
Results: There were 22 women with an age of 42 ± 6.3 years, average disease evolution 7.5 ± 6.6 years, of whom, 18 concluded the study. Right basal CIMT was 0.829 ± 0.1448 vs. final 0.688 ± 0.1453, p ‹ 0.003; left CIMT was 0.820 ± 0.1312 vs. 0.724 ± 0.1348, p ‹ 0.004. TC 208 mg/dl vs 168 mg/dl, LDL-C 125 mg/dl vs. 72 mg/dl, p = 0.0004. CRP 3.12 vs. 2.25 p = 0.004. In 2 cases there were gastrointestinal, skin and muscle adverse effects.
Conclusions: Treatment with pravastatin plus ezetimibe decreases the CIMT with improvement in the concentration of total cholesterol, LDL-C and CRP levels with good toleration.

REFERENCES

1. Ross R. Atherosclerosis an infl amatroy disease. N Engl J Med 1999,340:115-26.

2. Nikpour M, Urowitz M, Galdman D. Premature atherosclerosis in systemic lupus erythematosus. Rheum Dis Clin N Am 2005,31:329-354.

3. Urowitz M, Bookman A, Koehler B, Gordon D, Smythe H, Ogryzlo M. The bimodal mortality pattern of systemic lupus erythematosus. Am J of Med 1976; 60(2):221-5

4. Asanuma Y, Oeser A, Shintani A, Turner E, Olsen N, Fazio S, et al. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003;349:2407-15.

5. Manzi S, Meilan E, Raire J, Conte C, Medsger T, Jansen-Mc Williams L. Age-specifi c incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus- comparison with the Framingham study. Am J Epidemiol 1997;145(5): 408-15.

6. Leuven SI, Kastelein JJP, D´Cruz DP, Hughes GR, Stroes ES. Atherogenesis in rheumatology. Lupus 2006;15:117-121.

7. Roman M, Shanker B, Davis A, Lockshin M, Samaritano L, Simantov R, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003; 349:2399-406.

8. Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panatris C, du Berger R. et al. Traditional Framingham risk factors fail to fully account for eccelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001;44:2331-7.

9. Frieri, M. Accelerated aterosclerosis in systemic lupus erithematosus: role of proinfl amatory cytokines and therapeutic approaches. Curr Allergy Asthma Rep. 2012;12(1):25-32

10. Manzi S, Selzer F, Sutton-Tyrell K, Fitzgerald S, Rairie J, Tracy R. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rehum 1999;42:51-60.

11. Sutton K, Wolfson S, Thompson T, Kelsey S. Measurement variability in duplex scan assessment of carotid atherosclerosis. Stroke 1992;23:215-20.

12. Grobbee D, Bots M. Carotid intima-media thickness as an indicator of generalized atherosclerosis. J Intern Med 1994;236:567-73.

13. Vlachoyiannopoulos P, Kanellopoulos P, Ioannidis J, Tektonidou M, Mastorakou I, Moutsopoulos H. Atherosclerosis in premenopausal women with antiphospholipid syndrome and systemic lupus erythematosus: a controlled study. Rheumatology 2003; 42(5):645-51.

14. Selzer F, Sutton-Tyrrell K, Fitzgerald SG, Pratt J, Tracy R, Kuller L, et al. Comparison of Risk Factors for Vascular Disease in the Carotid artery and aorta in women with systemic lupus erythematosus. Arthritis Rheum 2004;50(5):151-9.

15. Salonen J, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arteriosclerosis and Thrombosis 1991;11:1245-49

16. Riboldi P, Gerosa M, Moroni PL. Statins and autoinmune diseases. Lupus 2005;14:765-68.

17. Wierzbicki AS. Lipid-lowering drugs in lupus: an unexplored therapeutic intervention. Lupus 2001;10: 233-36.

18. Kastelein J, Sager P, Groot E, Veltri E. Comparison of ezetimibe plus simvastatin versus simvastatin monotherapy on atherosclerosis progression in familial hypercholesterolemia: Design and rationale of ezetimibe and simvastatin in hypercholesterolemia enhances atherosclerosis regression (ENHANCE) trial. Am Heart J 2005;149:234-9

19. Kosoglou T, Statkevich P, Johnson-Levonas A, Paolini J, Bergman A, Alton K. Ezetimibe. A review of its metabolism, pharmacokinetics and drug interactions. Clin Pharmacokinet 2005;44:467-94

20. Ballantyne C, Blazing M, King T, Brady W, Palmisano J. Effi cacy and safety of ezetimibe co-administered with simvastatin compared with atorvastatin in adults with hypercholesterolemia. Am J Cardiol 2004;93:1487-94.

21. Smilde TJ, van Wissen S, Wollersheim H, Trip M, Kastelein JJ, Stalenhoef A. Effect of aggressive versus conventional lipid lowering on atherosclerosis progression in familial hypercholesterolemia (ASAP): a prospective, randomized, doble-blind trial. Lancet 2001;357:577-81

22. Gagné C, Bays H, Weiss S, Mata P, Quinto K, Melino M, et al. Effi cacy and safety of ezetimibe added to ongoing statin therapy for treatment of patients with primary hypercholesterolemia. Am J Cardiol 2002; 90:1084-91

23. Tyrrell PN, Beyene J, Feldman BM, McCrindle BW, Silverman ED, Bradley TJ.Rheumatic disease and carotid intima-media thickness: a systematic review and meta-analysis. Arterioscler Thromb Vasc Biol. 2010;30(5):1014-26.

24. Mok CC, Wong CK, To CH, Lai JP, Lam CS Effects of rosuvastatin on vascular biomarkers and carotid atherosclerosis in lupus: a randomized, doubleblind, placebo-controlled trial. Arthritis Care Res (Hoboken). 2011;63(6):875-83.

25. Petri MA, Kiani AN, Post W, Christopher-Stine L, Magder LS. Lupus Atherosclerosis Prevention Study (LAPS). Ann Rheum Dis. 2011;70(5):760-5.

26. Ruiz-Limon P, Barbarroja N, Perez-Sanchez C, Aguirre MA, Bertolaccini ML, Khamashta MA, Rodriguez- Ariza A, Almadén Y, Segui P, Khraiwesh H, Gonzalez-Reyes JA, Villalba JM, Collantes-Estevez E, Cuadrado MJ, Lopez-Pedrera C. Atherosclerosis and cardiovascular disease in systemic lupus erythematosus: effects of in vivo statin treatment. Ann Rheum Dis. 2014 Mar 21. doi: 10.1136/annrheumdis- 2013-204351. [Epub ahead of print]

27. Barbosa SP, Lins LC, Fonseca FA, Matos LN, Aguirre AC, Bianco HT, Amaral JB, França CN, Santana JM, Izar MC.Effects of ezetimibe on markers of synthesis and absorption of cholesterol in high-risk patients with elevated C-reactive protein. Life Sci. 2013;92(14-16):845-51.

28. van der Graaf A, Cuffi e-Jackson C, Vissers MN, Trip, Gagné C, Shi G, Veltri E, Avis HJ, Kastelein JJ. Effi cacy and safety of coadministration of ezetimibe and simvastatin in adolescents with heterozygous familial hypercholesterolemia. J Am Coll Cardiol. 2008;52(17):1421-9.

29. Kastelein JJ, Akdim F, Stroes ES, Zwinderman AH, Bots ML, Stalenhoef AF, Visseren FL, Sijbrands EJ, Trip MD, Stein EA, Gaudet D, Duivenvoorden R, Veltri EP, Marais AD, de Groot E; ENHANCE Investigators. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358(14): 1431-43.