Low-density lipoprotein cholesterol lowering by adding ezetimibe to statin is associated with improvement of postprandial hyperlipidemia in diabetic patients with coronary artery disease

Objective and methods

We investigated the hypothesis that serum low-density lipoprotein cholesterol (LDL-C) reduction by ezetimibe is associated with the improvement in postprandial hyperlipidemia by performing an oral fat loading test before and 24 weeks after ezetimibe treatment in diabetic (n = 29) and non-diabetic (n = 30) male patients with coronary artery disease (CAD).

Results

Serum LDL-C levels were significantly reduced by ezetimibe in both groups (diabetic, from 120.3 ± 39.4 to 79.5 ± 23.2 mg/dL, p < 0.001; non-diabetic, from 98.2 ± 41.7 to 76.7 ± 29.2 mg/dL, p < 0.001), and the mean reduction in serum LDL-C was greater in diabetic than non-diabetic patients (− 32.0 vs. − 19.0%, p = 0.004). The area under the curve (AUC) for triglyceride (TG) and remnant-like particle cholesterol (RLP-C) decreased significantly in both groups. When compared with the reduction before and after treatment in AUC of TG (∆ AUC_0–6 h TG) and RLP-C (∆ AUC_0–6 h RLP-C), they were significantly greater in diabetic than non-diabetic patients (∆ AUC_0–6h TG, − 28.9 vs. − 12.2%, p = 0.028; ∆ AUC_0–6h RLP-C, − 27.8 vs. − 12.3%, p = 0.007). In diabetic patients, ∆ AUC_0–6 h TG and ∆ AUC_0–6 h RLP-C in the highest tertile of serum LDL-C reduction were significantly greater than those in the lowest tertile (∆ AUC_0-6h TG, − 34.1 vs. − 20.9%, p = 0.012; ∆ AUC_0-6h RLP-C, − 34.5 vs. − 15.1%, p = 0.024).

Conclusions

These findings suggest that serum LDL-C reduction by ezetimibe might be associated with the improvement of postprandial hyperlipidemia in diabetic patients with CAD.