Rosuvastatin and Ezetimibe combo useful alternative to high dose Rosuvastatin after drug-eluting stent implantation

A recent study published in the Journal of the American College of Cardiology found that combination lipid-lowering therapy with Rosuvastatin 10 mg plus Ezetimibe 10 mg can be used as an alternative to Rosuvastatin 20 mg monotherapy as the combination therapy was associated with better clinical outcomes and good drug compliance in patients treated with drug-eluting stent implantation. 

Statins reduce coronary morbidity and mortality in patients with coronary artery disease. The protective action of statins is due to their independent pleiotropic effects, anti-inflammatory effects, and the reduction of low-density lipoprotein cholesterol along with improved endothelial function. Recent literature suggested that when compared to high-intensity statin monotherapy, combination therapy can be used as an alternative. Hence researchers conducted the RACING trial to examine the effects of combination therapy with moderate-intensity statin and ezetimibe in patients with atherosclerotic cardiovascular disease compared with high-intensity statin monotherapy. 

A nationwide cohort database was used to identify 72,050 patients who received rosuvastatin prescriptions following the implantation of drug-eluting stents. Of these, 10,794 patients received rosuvastatin 10 mg in combination with ezetimibe 10 mg, and 61,256 patients received rosuvastatin 20 mg as monotherapy. According to the RACING trial, the primary outcome was the 3-year composite event of cardiovascular death, myocardial infarction, coronary artery revascularization, hospitalization for treatment of heart failure, or nonfatal stroke.

Key Findings: 

• There was a lower occurrence of the primary endpoint with the combination lipid-lowering therapy. 
• Compared with high-intensity statin monotherapy, combination lipid-lowering therapy was associated with fewer discontinuations of statin and a lower occurrence of new-onset diabetes requiring medication. 

Thus, the combination of lipid-lowering therapy with ezetimibe and moderate-intensity statin had better clinical outcomes and drug compliance in patients treated with drug-eluting stent implantation. 

Further reading: Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention. J Am Coll Cardiol. 2023 Aug, 82 (5) 401–410