Title

Simvastatin With or Without Ezetimibe and Atherothrombotic Biomarker Assessment
The Effects of Ezetimibe/Simvastatin Versus Simvastatin Alone on Platelet and Inflammatory Biomarkers in Patients With the Metabolic Syndrome
  • Phase

    Phase 4
  • Study Type

    Interventional
  • Study Participants

    15
To determine whether the combination of ezetimibe and simvastatin improves biomarkers of atherothrombosis compared to simvastatin alone in patients with the metabolic syndrome.
To assess the ex vivo effects of ezetimibe/simvastatin (E/S) (Vytorin 10/40mg) and simvastatin (S) (Zocor 40mg) on platelet and inflammation biomarkers in patients with documented metabolic syndrome.
To compare platelet-related effects including PAR-1 receptor inhibition of E/S with those of the established anti-platelet agents including aspirin, clopidogrel, intravenous and oral glycoprotein IIb/IIIa inhibitors.
To determine whether the addition of ezetimibe will yield extra protection beyond lipid modulation in the reduction of inflammation and platelet activation.
Study Started
Jan 31
2009
Primary Completion
Nov 30
2011
Study Completion
Nov 30
2011
Results Posted
Dec 18
2014
Estimate
Last Update
Jan 14
2020

Drug simvastatin

Subjects will receive 6 weeks of simvastatin 40 mg, after which atherothrombotic biomarker assessment will be studied.

  • Other names: zocor

Drug ezetimibe/simvastatin

Subjects will receive 6 weeks of ezetimibe/simvastatin 10/40 mg, after which atherothrombotic biomarker assessment will be studied.

  • Other names: vytorin

simvastatin Active Comparator

Simvastatin 40 mg daily

simvastatin/ezetimibe Active Comparator

Subjects will receive 6 weeks of ezetimibe/simvastatin 10/40 mg, after which atherothrombotic biomarker assessment will be studied.

Criteria

Inclusion Criteria:

Men and women greater than or equal to 21 years of age

Diagnosis of metabolic syndrome. We defined the presence of metabolic syndrome based on the US National Cholesterol Education Program's Adult Treatment Panel III guidelines. Specifically, metabolic syndrome will be diagnosed and documented when 3 of the following 5 characteristics will be present:

abdominal obesity, given as waist circumference for men > 102 cm, and for women > 88 cm
triglycerides > 150 mg/dL
HDL cholesterol < 40 mg/dL for men, and < 50 mg/dL for women
blood pressure > 130/85 mm Hg
fasting glucose > 100 mg/dL

Exclusion Criteria:

Patients will be excluded for a history of bleeding diathesis
drug or alcohol abuse
prothrombin time greater than 1.5 times control
platelet count < 100,000/mm3
hematocrit < 25%
creatinine > 4.0 mg/dl
surgery or angioplasty performed within 3 months or planned for the future
history of gastrointestinal or other bleeding
history of drug-induced disorders
trauma, cancer, rheumatic diseases, coronary artery disease or stroke
Patients participating in other investigational drug trials within one month of completion will be also excluded
Patients treated with intravenous platelet glycoprotein IIb/IIIa inhibitors or thienopyridines, within past 6 months
Patients treated with statins or aspirin within past four weeks

Summary

Simvastatin

Simvastatin/Ezetimibe

All Events

Event Type Organ System Event Term Simvastatin Simvastatin/Ezetimibe

Ex Vivo Effects of Treatment With Vytorin Versus Zocor for 6 Weeks on Platelet Alpha Thrombin PAR-1 Receptor Expression

Measured using whole blood flow cytometry

Simvastatin

PAR 1/4 activity

23.6
ng/dl (Mean)
Standard Deviation: 4.3

PAR 1/4 antigen

35.4
ng/dl (Mean)
Standard Deviation: 5.2

Simvastatin/Ezetimibe

PAR 1/4 activity

22.5
ng/dl (Mean)
Standard Deviation: 6.2

PAR 1/4 antigen

34.5
ng/dl (Mean)
Standard Deviation: 5.4

Biomarkers of Inflammation

Simvastatin

CRP

3.51
mg/dl (Mean)
Standard Deviation: .48

IL-6

1.24
mg/dl (Mean)
Standard Deviation: .12

Simvastatin/Ezetimibe

CRP

3.57
mg/dl (Mean)
Standard Deviation: .34

IL-6

1.33
mg/dl (Mean)
Standard Deviation: .21

Total

15
Participants

Age, Continuous

48.5
years (Mean)
Standard Deviation: 10.1

Age, Categorical

Region of Enrollment

Sex: Female, Male

First Intervention (6 Weeks)

Simvastatin Then Simvastatin/Ezetimibe

Simvastatin/Ezetimibe Then Simvastatin

Washout (14 Days)

Simvastatin Then Simvastatin/Ezetimibe

Simvastatin/Ezetimibe Then Simvastatin

Second Intervention (6 Weeks)

Simvastatin Then Simvastatin/Ezetimibe

Simvastatin/Ezetimibe Then Simvastatin