Endothelial function in high-risk patients with ezetimibe therapy

BACKGROUND: Impaired endothelial function predicts cardiovascular (CV) events, even in patients with established atherosclerotic CV disease (ASCVD). The aim of this post hoc analysis was to compare the endothelial function between high-risk patients on optimized statin therapy with and without additional ezetimibe treatment. METHODS: A total of 91 patients with ASCVD and statin treatment (atorvastatin or rosuvastatin) were included and underwent examination of endothelial function by the UNEX EF device. Endothelial function parameters were compared between patients with ezetimibe (E+ group) and without ezetimibe therapy (E- group) (NCT03626831). RESULTS: Compared to patients in the E- group (n = 70), patients in the E+ group (n = 21) were younger (67.0 ± 7.4 vs 61.2 ± 7.2 years; P = .002), had lower low-density lipoprotein cholesterol (91.2 ± 13.3 vs 102.0 ± 18.1 mg/dL; P = .013) and lower office systolic blood pressure (123.9 ± 11.4 vs 130.2 ± 14.5 mm Hg; P = .042). High-sensitivity C-reactive protein (hsCRP) was lower in the E+ group than in the E- group (0.5 ± 0.4 vs 1.1 ± 0.9 mg/L; P = .037). We found a greater flow-mediated vasodilation (FMD) (6.1 ± 2.0 vs 3.7 ± 3.2%; P = .004) and lower brachial intima-media thickness (0.28 ± 0.1 vs 0.32 ± 0 mm; P = .011) in the E+ group compared to the E- group. When confounders were entered in a covariance analysis, the differences in FMD (P = .034) and hsCRP (P = .049) between the groups remained significant. CONCLUSION: In this cross-sectional analysis, we observed a difference of FMD suggesting potentially better endothelial function in high-risk ASCVD patients on ezetimibe plus statin compared to statin monotherapy; however, causal conclusions cannot be drawn.