الفهرس 
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Abstract
Atherosclerotic diseases with high triglyceride levels can be found in patients with familial combined hyperlipidemia, diabetes mellitus, and metabolic syndrome, in which remnant lipoproteins (RLPs) accumulate in the circulating blood. Many patients with diabetic dyslipidemia fail to achieve their low density lipoprotein cholesterol (LDL-C) goals with statin mono therapy. Therefore, an increase in statin dose or combination with other lipid-lowering drugs is required.
Although several previous reports showed that ezetimibe lowered triglyceride-rich lipoproteins, it remains undetermined whether addition of ezetimibe to ongoing statin therapy is more effective than increasing statin dose for reducing RLPs. This study aimed to investigate the efficacy of adding ezetimibe to ongoing atorvastatin dose compared to doubling the atorvastatin dose in diabetic patients with remnant lipoproteinemia, and to assess the effects of both treatment modalities on RLP-C, non-HDL cholesterol, apolipoprotein B, endothelial function, and lipid profile. Sixty five eligible patients were recruited and prospectively randomized to receive ezetimibe 10 mg/day plus their 40 mg daily atorvastatin dose (group 1, n = 33), or atorvastatin 80 mg/day (group 2, n = 32) for 3 months. Efficacy was evaluated using plasma levels of RLP-C, apolipoprotein B, non-high density lipoprotein cholesterol (non-HDL), percentage of brachial artery flow-mediated dilation (% FMD), and lipid profile. 20 patients in each group completed the study and provided efficacy data. group 1 showed more reduction in RLP-C (45.7 % versus 31.7 %, P = 0.02); apolipoprotein B (28.5 % versus 9.5 %, P = 0.01); total cholesterol (34.7 % versus 24.6 %, P = 0.003); triglyceride (49 % versus 24.4 %, P = 0.000); non-HDL (49.3 % versus 33 %, P = 0.002); and LDL (49.6 % versus 35.2 %, P = 0.02) compared to group 2. group 1 showed more increase in HDL (66 % versus 35 %, P = 0.002); and % FMD (30 % versus 17 %, P = 0.01) compared to group 2. It can be concluded that, adding ezetimibe 10 mg to atorvastatin 40 mg can be a better choice than doubling atorvastatin dose in improving RLPs; endothelial function; and lipid profile in diabetic cardiovascular patients who couldn’t achieve their therapeutic treatment goals with standard atorvastatin dose.