Evidence for Cholesterol Hyperabsorbers and Hyperproducers Based on Comparative Low-Density Lipoprotein Reductions Achieved by Ezetimibe Versus Statins
Bibliographic record
Abstract
In Brief PURPOSE: To investigate the hypothesis that some patients are hyperproducers of cholesterol while others are hyperabsorbers by comparing the low-density lipoprotein (LDL) responses to statins versus ezetimibe adjunct therapy. METHODS: Consecutive patients (N = 109), who received statin monotherapy followed by ezetimibe adjunct therapy, were prospectively studied. The expected LDL levels for each patient on statin and on ezetimibe adjunct therapy were calculated. The difference between expected and actual LDL levels on statin and on ezetimibe adjunct therapy was calculated for each patient and subsequently correlated. RESULTS: The mean LDL levels (mg/dL) were baseline, 168.7 ± 3.6; on statin, 104.2 ± 2.6; on ezetimibe adjunct, 74.2 ± 2.2. Statins reduced LDL by 36.7 ± 1.5%, while adding ezetimibe resulted in a further reduction of 28.1 ± 1.4%. The percent LDL reduction by statin was negatively correlated to the percent reduction by ezetimibe adjunct therapy (r = −0.29, P = .002). The difference between expected and actual LDL levels on statin was negatively correlated to that on ezetimibe adjunct therapy (r = −0.38, P < .001). CONCLUSIONS: This study demonstrated that the LDL response to ezetimibe is inversely related to the response to statin. This lends support to the hypothesis that some patients may be hyperabsorbers of cholesterol while others may be hyperproducers. This suggests that a less than expected response to the initial dose of statin in a patient would likely require the addition of ezetimibe to achieve the recommended target levels in spite of the use of maximum dose statin therapy. This study compared the low-density lipoprotein (LDL) responses in 109 consecutive patients with statins versus ezetimibe adjunct therapy. Percent LDL reduction by statin was negatively correlated to percent reduction by adding ezetimibe, suggesting that some patients may be hyperabsorbers while others may be hyperproducers of cholesterol.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".