In a post hoc analysis, we explored the bivariate relationships between changes in LDL cholesterol levels and mean carotid intima–media thickness. There was a significant inverse relationship between the changes in LDL cholesterol level and the carotid intima–media thickness in the ezetimibe group (R=–0.31, P<0.001), such that a paradoxical increase in the carotid intima–media thickness was seen in patients with greater reductions in LDL cholesterol. Such a relationship was not observed in the niacin group (R=–0.01, P=0.92) (Fig. 4 in the Supplementary Appendix).
This paradoxical negative correlation is another worrying sign for Zetia.
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