Upfront combination therapy of statin and ezitamide may transform cardiac care, suggests research

Ochsner Health Medical Director for Cardiac Rehabilitation and Preventive Cardiology, Carl J. "Chip" Lavie, Jr., MD, recently co-authored a groundbreaking research study featured in the prestigious Mayo Clinic Proceedings highlighting the comparative efficacy of lipid-lowering therapies for reducing cardiovascular risks and led by Maciej Banach, MD,PhD from Poland and leader of the International Lipid Expert Panel ( ILEP). Impact of Lipid-Lowering Combination Therapy With Statins and Ezetimibe vs Statin Monotherapy on the Reduction of Cardiovascular Outcomes: A Meta-analysis explores the outcomes of combination lipid-lowering therapy (LLT) using statins and ezetimibe relative to statin monotherapy and could prevent thousands of deaths due to heart disease and stroke.

With a comprehensive evaluation of 14 studies encompassing over 108,000 high-risk individuals, the analysis reveals that the combination of statins with ezetimibe markedly lowers LDL cholesterol levels, achieving a mean reduction difference of -12.96 mg/dL and significantly diminishing the risk of all-cause mortality by 19%, major adverse cardiovascular events by 18%, and stroke incidence by 17%. The research underscores the comparable safety profile of combination LLT to statin monotherapy, with both approaches presenting similar risks of adverse effects and therapy discontinuation.

This pivotal study advocates for the integration of combination therapy early in treatment protocols, particularly for high and very high-risk groups. It highlights the potential for this integrative approach to not only meet LDL-C targets more effectively but also to substantially curtail mortality and CVD events.

Dr. Lavie stated, "The findings underscore the importance of a proactive, combination-based strategy in lipid-lowering therapy. By optimizing LDL-C reductions early, we can dramatically improve patient outcomes and reduce the global burden of cardiovascular disease."

The study authors encourage early intervention with combinations therapy in very high-risk patients, even before they suffer a cardiac event or stroke. By adopting a framework that includes upfront combination therapy, clinicians can enhance patient outcomes in the management of cardiovascular risks and diseases. This research represents significant progress toward optimizing prevention strategies and improving patient outcomes. 

Reference:

Maciej Banach, Vikash Jaiswal, Song Peng Ang, Aanchal Sawhney, Novonil Deb, Pierre Amarenco, Dan Gaita, Zeljko Reiner, Ivan Pećin, Carl J. Lavie, Peter E. Penson, Peter P. Toth, Impact of Lipid-Lowering Combination Therapy With Statins and Ezetimibe vs Statin Monotherapy on the Reduction of Cardiovascular Outcomes: A Meta-analysis, Mayo Clinic Proceedings, https://doi.org/10.1016/j.mayocp.2025.01.018.