エゼチミブは一次予防目的の標準治療として最良である(Abstract 17581)

EWTOPIA 75：日本人高齢患者における動脈硬化性疾患の一次予防目的としてエゼチミブは標準治療よりも優れている
EWTOPIA 75: Ezetimibe better than standard care for primary prevention of atherosclerotic disease in elderly Japanese patients
コレステロール吸収阻害薬エゼチミブで治療された高齢患者は、標準治療を受けた患者に比べ動脈硬化性心血管イベントのリスクが有意に低かった。EWTOPIA 75試験は、高LDLコレステロール値（≧140 mg/dL）で心血管疾患歴を有さない患者3,796人を、栄養指導を受けエゼチミブを内服するまたはしない群に組み入れた。両群とも5年にわたりLDLコレステロールが低下したが、エゼチミブ治療群で低下度が高かった（p<0.001）。エゼチミブは心血管イベント（突然死、心筋梗塞、PCIまたはCABG、および／または脳卒中、p=0.002）を有意に予防した。この結果は、American Heart Association Scientific Sessions 2018 で発表された。
Full Text

Elderly patients treated with the cholesterol-absorption inhibitor ezetimibe had a significantly lower risk of atherosclerotic cardiovascular events over 5 years when compared with patients who received standard care, according to the results of the EWTOPIA 75 trial presented at a Late Breaking Science session at the American Heart Association 2018 Scientific Sessions.

The EWTOPIA 75 trial was a multicenter, prospective, open-label randomized controlled trial in Japan.  It evaluated the effect of lipid-lowering therapy by ezetimibe on the primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in 3,796 old-old patients (75 years or older) with elevated LDL-cholesterol level (≥ 140 mg/dL) and no history of cardiovascular disease. Mean patient age was 80.7 years, and 74% of the population was female.  Patients in the study received dietary counseling with or without a daily dose of ezetimibe 10 mg.

Both groups saw reductions in LDL cholesterol over 5 years, but there was a larger reduction observed in the ezetimibe-treated patients. For those treated with ezetimibe, LDL cholesterol was reduced from 161.3 to 120.1 mg/dL, while patients just counselled on diet reduced their LDL levels from 162.0 to 131.4 mg/dL (P < 0.001 for interaction).

Lowering LDL cholesterol by ezetimibe monotherapy significantly prevented ASCVD events (sudden cardiac death, MI, PCI or CABG, and/or stroke, hazard ratio 0.66, p=0.002). 

The study was led by Yasuyoshi Ouchi, M.D., Ph.D., Tokyo Metropolitan Institute of Gerontology, Japan.  Dr. Ouchi reports no relevant conflicts of interest.