Ezetimibe with statin therapy reduces risk of CV events even in patients with low LDL-C: Study
USA: According to a recent study in the Journal of the American College of Cardiology (JACC), ezetimibe addition to statin consistently reduces the risk for cardiovascular (CV) events in post-acute coronary syndrome (ACS) patients. The risk reduction was irrespective of baseline LDL-C values, implying the use of intensive lipid-lowering therapy with ezetimibe even in patients with baseline LDL-C <70 mg/dL.
Additional lipid-lowering therapy with ezetimibe is recommended in the 2018 U.S. cholesterol management guideline for secondary prevention in very high-risk patients with low-density lipoprotein cholesterol (LDL-C) ≥70 mg/dL despite maximally tolerated statin.
To fill this knowledge gap, Kazuma Oyama, Harvard Medical School, Boston, Massachusetts, USA, and colleagues aimed to evaluate the relationship between baseline LDL-C above and below 70 mg/dL and the benefit of adding ezetimibe to a statin in patients post-acute coronary syndrome (ACS).
IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) is a double-blind, placebo-controlled, randomized trial of ezetimibe/simvastatin vs placebo/simvastatin in post-ACS patients followed for 6 years (median). A total of 17,999 patients were stratified by LDL-C at qualifying event into 3 groups (50-<70, 70-<100, and 100-125 mg/dL). The primary endpoint was a composite of cardiovascular death, major coronary events, or stroke.
The study yielded the following findings:
- Absolute differences in median LDL-C achieved at 4 months between treatment arms were similar (17-20 mg/dL).
- The effect of ezetimibe/simvastatin vs placebo/simvastatin on primary endpoint was consistent regardless of baseline LDL-C of 50-<70 mg/dL (HR: 0.92), 70-<100 mg/dL (HR: 0.93), or 100-125 mg/dL (HR: 0.94).
- Normalized relative risk reductions per 1-mmol/L difference in achieved LDL-C at 4 months between treatment arms were 21% in patients with baseline LDL-C of 50-<70 mg/dL, 16% in those with 70-<100 mg/dL, and 13% in those with 100-125 mg/dL.
- No significant treatment interactions by baseline LDL-C were present for safety endpoints.
The researchers concluded that adding ezetimibe to statin consistently reduced the risk for CV events in post-ACS patients irrespective of baseline LDL-C values, supporting the use of intensive lipid-lowering therapy with ezetimibe even in patients with baseline LDL-C <70 mg/dL.
Reference:
The study titled, "Baseline Low-Density Lipoprotein Cholesterol and Clinical Outcomes of Combining Ezetimibe With Statin Therapy in IMPROVE-IT," is published in the Journal of the American College of Cardiology (JACC).
DOI: https://www.jacc.org/doi/10.1016/j.jacc.2021.08.011
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.