NEW YORK (Reuters Health) – Intensive treatment to lower low-density lipoprotein cholesterol (LDL-C) reduces carotid intima-media thickness (CIMT) in patients with type 2 diabetes, according to a secondary analysis from the Stop Atherosclerosis in Native Diabetics Study (SANDS) trial.

The beneficial effect on CIMT regression is similar in patients who attain equivalent LDL-C reductions from a statin alone or a statin plus ezetimibe. However, the addition of ezetimibe may be required if statin monotherapy fails to lower LDL-C to target levels, the investigators report in the Journal of the American College of Cardiology for December 16/23.

The SANDS trial was a 3-year, randomized trial that examined the effects of aggressive goals for LDL-C (70 mg/dL or lower) and non-HDL-C (100 mg/dL or lower) versus standard goals (100 mg/dL or lower for LDL-C and < 130 mg/dL for non-HDL-C). If the LDL-C goal was not reached with a statin alone in the aggressive group, ezetimibe was added.

The study involved 427 Native Americans age 40 years and older with type 2 diabetes and no prior cardiovascular events. There were 204 subjects in the standard treatment group and 223 subjects in the aggressive group — 154 treated with statins alone and 69 who received statin plus ezetimibe.

Carotid ultrasound showed CIMT progression in the standard group (mean 0.039 mm) and similar degrees of CIMT regression in the aggressive groups (-0.025 mm in ezetimibe plus statin, -0.012 mm in the statin monotherapy group). Nearly identical proportions in the 2 aggressive subgroups demonstrated no change or a decrease in CIMT during follow-up, Dr. Wm. James Howard at MedStar Research Institute in Hyattsville, Maryland, and co-authors report.

In a multivariate model, “comparable LDL-C and non-HDL-C lowering accomplished with statins plus ezetimibe versus statins alone resulted in similar benefit on CIMT.”

Dr. Howard’s team adds: “Whether addition of ezetimibe to aggressive statin therapy will translate into lower CV event rates in populations without prior CV events must await the results of ongoing trials. In the interim, ezetimibe remains a viable therapeutic option for patients who fail to reach their LDL-C target on a statin alone.”

J Am Coll Cardiol 2008;52.