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DyslipidemiaNCT02304926

Effects of Simvastatin and Ezetimibe on Cardiovascular Risk Markers in Patients With Dyslipidemia

A study testing Simvastatin, Ezetimibe and Simvastatin + Ezetimibe in people with Dyslipidemia, run by Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Coadministration of drugs is common in the pharmacologic treatment of dyslipidemia, with statins and ezetimibe generally constituting the medication of choice. By acting at different levels, the combination of these drugs allows the therapeutic objective to be achieved. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Dyslipidemia
What is being tested?
Simvastatin, Ezetimibe and Simvastatin + Ezetimibe
Could I receive a placebo?
No, everyone receives an active treatment
How many people
42 participants
Where
No sites listed yet
Study dates
Jan 2009to Dec 2011
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • LDL cholesterol concentration of between 160-190 mg/dl in patients with less than 2 cardiovascular risk factors
  • LDL concentration of between 130-160 mg/dl in patients that presented 2 or more cardiovascular risk factors.
  • Cardiovascular risk factors were defined as: age (≥ 45 years in men and ≥55 years in women), a smoking habit, hypertension (≥140/90 mmHg), diabetes mellitus, a high-density lipoprotein (HDL) cholesterol concentration of ≤ 40mg/dl, and a family history of cardiovascular disease.

Who cannot join

  • Triglyceride concentration > 400 mg/dl
  • Diabetes Mellitus
  • Kidney, liver, or thyroid disease

About this study

Official title: Study of Lipoprotein Subfractions, Inflammation, Oxidative Stress and Endothelial Function After Treatment With Simvastatin and Ezetimibe Administered Alone and in Combination in Hyperlipidemic Patients

Coadministration of drugs is common in the pharmacologic treatment of dyslipidemia, with statins and ezetimibe generally constituting the medication of choice. By acting at different levels, the combination of these drugs allows the therapeutic objective to be achieved. However, it is not known how these drugs qualitatively affect the composition of lipoprotein subfractions, which differ in size and atherogenic potential. The investigators set out to evaluate this effect as well as their effects on inflammatory, oxidative stress and endothelial function parameters.

Read the detailed description

The study consisted of a randomised parallel trial and took place during a period of 2 months. A total of 42 hyperlipidemic patients were randomly assigned to one of 2 groups: one received simvastatin (40 mg/day) and the other received ezetimibe (10 mg/day) for 4 weeks, after which both groups were administered combined therapy for an additional 4-week period. Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.

Conditions
Dyslipidemia
Being tested
Simvastatin, Ezetimibe, Simvastatin + Ezetimibe
Keywords
Dyslipidemia, Simvastatin, Ezetimibe, Lipid profile, Inflammation, Oxidative stress, Endothelial function
Medical subject headings
Dyslipidemias, Inflammation

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • SimvastatinDrug

    simvastatin (40 mg/day) for 4 weeks

  • EzetimibeDrug

    ezetimibe (10 mg/day) for 4 weeks

  • Simvastatin + EzetimibeDrug

    combined therapy simvastatin (40 mg/day) + ezetimibe (10 mg/day) for 4-week period

Study groups in NCT02304926
Study groupRoleWhat they receive
SimvastatinExperimentalHyperlipidemic patients received simvastatin (40 mg/day) for 4 weeks, after they were administered combined therapy (simvastatin, 40 mg/day plus ezetimibe,10 mg/day) for an additional 4-week period. Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.
Receives: Drug: Simvastatin; Drug: Simvastatin + Ezetimibe
EzetimibeExperimentalHyperlipidemic patients received ezetimibe (10 mg/day) for 4 weeks, after they were administered combined therapy (simvastatin, 40 mg/day plus ezetimibe,10 mg/day) for an additional 4-week period. Lipid profile, lipoprotein subfractions of LDL and HDL, inflammatory, oxidative stress and endothelial function parameters were evaluated.
Receives: Drug: Ezetimibe; Drug: Simvastatin + Ezetimibe

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Total Cholesterol Before and After Simvastatin/Ezetimibe Administration

    Total cholesterol concentration was measured by enzymatic assay

    Measured: Baseline, 4 weeks and 8 weeks

  2. Low-density Lipoprotein Cholesterol (LDLc) Before and After Simvastatin/Ezetimibe Administration

    Low-density lipoprotein cholesterol (LDLc) concentration was calculated using the method of Friedewald.

    Measured: Baseline, 4 weeks and 8 weeks

  3. High-density Lipoprotein Cholesterol (HDLc) Before and After Simvastatin/Ezetimibe Administration

    High-density lipoprotein cholesterol (HDLc) concentration was measured using a direct method

    Measured: Baseline, 4 weeks and 8 weeks

  4. Triglycerides Before and After Simvastatin/Ezetimibe Administration

    Triglyceride concentration were measured by enzymatic assay

    Measured: Baseline, 4 weeks and 8 weeks

  5. Non-HDL Cholesterol Before and After Simvastatin/Ezetimibe Administration

    Non-HDLc concentration was obtained by calculating the difference between total cholesterol and HDLc

    Measured: Baseline, 4 weeks and 8 weeks

  6. Low Density Lipoprotein Size Before and After Simvastatin/Ezetimibe Administration

    LDL subfractions were separated by high-resolution polyacrylamide gel tubes using the Lipoprint® system. The LDL electrophoretic profile allows 2 patterns to be defined: pattern A or large and buoyant LDL, and pattern non-A or small and dense LDL.

    Measured: Baseline, 4 weeks and 8 weeks

  7. Apolipoprotein B Before and After Simvastatin/Ezetimibe Administration

    Levels of apolipoprotein B were determined by inmunonephelometry

    Measured: Baseline, 4 weeks and 8 weeks

Secondary outcomes (13)
  1. Levels of High-sensitive C-reactive Protein (hsCRP) Before and After Simvastatin/Ezetimibe Administration

    Levels of high-sensitive C-reactive protein (hsCRP) were analysed by a latex-enhanced inmunonephelometric assay

    Measured: Baseline, 4 weeks and 8 weeks

  2. Levels of Interleukin-6 (IL-6) Before and After Simvastatin/Ezetimibe Administration

    Levels of proinflammatory cytokines (interleukin-6 (IL-6)) were analysed with a Luminex® 200™ system

    Measured: Baseline, 4 weeks and 8 weeks

  3. Levels of Tumor Necrosis Factor α (TNF-α) Before and After Simvastatin/Ezetimibe Administration

    Levels of proinflammatory cytokines (tumor necrosis factor α (TNF-α)) were analysed with a Luminex® 200™ system

    Measured: Baseline, 4 weeks and 8 weeks

  4. Mitochondrial Oxygen (O2) Consumption Before and After Simvastatin/Ezetimibe Administration

    Oxidative stress markers (mitochondrial oxygen (O2) consumption) was measured at baseline and after treatment by Clark electrode

    Measured: Baseline, 4 weeks and 8 weeks

  5. Reactive Oxygen Species (ROS) Production Before and After Simvastatin/Ezetimibe Administration

    Oxidative stress markers (Reactive oxygen species (ROS) production) was measured at baseline and after treatment by fluorometric techniques

    Measured: Baseline, 4 weeks and 8 weeks

  6. Membrane Potential Before and After Simvastatin/Ezetimibe Administration

    Oxidative stress markers (membrane potential) was measured at baseline and after treatment by fluorometric techniques

    Measured: Baseline, 4 weeks and 8 weeks

  7. Levels of Glutathione (GSH) Before and After Simvastatin/Ezetimibe Administration

    Oxidative stress markers (levels of glutathione (GSH)) was measured at baseline and after treatment by fluorometric techniques

    Measured: Baseline, 4 weeks and 8 weeks

  8. Leukocyte Rolling Flux Before and After Simvastatin/Ezetimibe Administration

    Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy. Leukocyte rolling was estimated as the number of leukocytes rolling over 100 μm2 of the endothelial monolayer during a 1-min period.

    Measured: Baseline, 4 weeks and 8 weeks

  9. Leukocyte Adhesion Before and After Simvastatin/Ezetimibe Administration

    Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy. Adhesion was evaluated by counting the number of polymorphonuclear cells that maintained stable contact with human umbilical vein endothelial cells (HUVEC) for 30 seconds.

    Measured: Baseline, 4 weeks and 8 weeks

  10. Leukocyte Rolling Velocity Before and After Simvastatin/Ezetimibe Administration

    Interactions between leukocytes and human umbilical vein endothelial cells were evaluated by flow chamber microscopy.The rolling velocity in the field of focus was determined by measuring the time required by 20 consecutive leukocytes to cover a distance of 100 μm.

    Measured: Baseline, 4 weeks and 8 weeks

  11. Levels of Vascular Cell Adhesion Molecule 1 (VCAM-1) Before and After Simvastatin/Ezetimibe Administration

    The vascular cell adhesion molecule 1 (VCAM-1) was evaluated in serum by Luminex® 200™ system

    Measured: Baseline, 4 weeks and 8 weeks

  12. Levels of Intercellular Adhesion Molecule 1 (ICAM-1) Before and After Simvastatin/Ezetimibe Administration

    The intercellular adhesion molecule 1 (ICAM-1) was evaluated in serum by Luminex® 200™ system

    Measured: Baseline, 4 weeks and 8 weeks

  13. Levels of E-selectin Before and After Simvastatin/Ezetimibe Administration

    E-selectin was evaluated in serum by Luminex® 200™ system

    Measured: Baseline, 4 weeks and 8 weeks

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted2 Dec 2014 (estimated)
  2. Study startJan 2009
  3. Primary completionDec 2011
  4. Study completionDec 2011

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
42 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02304926
Sponsor's protocol ID
SIM-EZE-2009-01
Status last verified
Feb 2018
First submitted
25 Nov 2014
Last updated
8 Mar 2018
Data monitoring committee
No

Publications

  • Berneis K, Rizzo M, Berthold HK, Spinas GA, Krone W, Gouni-Berthold I. Ezetimibe alone or in combination with simvastatin increases small dense low-density lipoproteins in healthy men: a randomized trial. Eur Heart J. 2010 Jul;31(13):1633-9. doi: 10.1093/eurheartj/ehq181. Epub 2010 Jun 6.

    PubMed 20525999
  • Florentin M, Liberopoulos EN, Moutzouri E, Rizos CV, Tselepis AD, Elisaf MS. The effect of simvastatin alone versus simvastatin plus ezetimibe on the concentration of small dense low-density lipoprotein cholesterol in subjects with primary hypercholesterolemia. Curr Med Res Opin. 2011 Mar;27(3):685-92. doi: 10.1185/03007995.2010.546394. Epub 2011 Jan 27.

    PubMed 21271793
  • Bays HE, Ose L, Fraser N, Tribble DL, Quinto K, Reyes R, Johnson-Levonas AO, Sapre A, Donahue SR; Ezetimibe Study Group. A multicenter, randomized, double-blind, placebo-controlled, factorial design study to evaluate the lipid-altering efficacy and safety profile of the ezetimibe/simvastatin tablet compared with ezetimibe and simvastatin monotherapy in patients with primary hypercholesterolemia. Clin Ther. 2004 Nov;26(11):1758-73. doi: 10.1016/j.clinthera.2004.11.016.

    PubMed 15639688

Questions about this trial

What is this clinical trial studying?

A study testing Simvastatin, Ezetimibe and Simvastatin + Ezetimibe in people with Dyslipidemia, run by Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 8 Mar 2018. Status can change between updates, so confirm with the study contact before making plans.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 21 May 2015). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Total Cholesterol Before and After Simvastatin/Ezetimibe Administration (time frame: Baseline, 4 weeks and 8 weeks). The study lists 7 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02304926, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 8 Mar 2018.

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