Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes.
Publication/Presentation Date
6-18-2015
Abstract
BACKGROUND: Statin therapy reduces low-density lipoprotein (LDL) cholesterol levels and the risk of cardiovascular events, but whether the addition of ezetimibe, a nonstatin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further is not known.
METHODS: We conducted a double-blind, randomized trial involving 18,144 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and had LDL cholesterol levels of 50 to 100 mg per deciliter (1.3 to 2.6 mmol per liter) if they were receiving lipid-lowering therapy or 50 to 125 mg per deciliter (1.3 to 3.2 mmol per liter) if they were not receiving lipid-lowering therapy. The combination of simvastatin (40 mg) and ezetimibe (10 mg) (simvastatin-ezetimibe) was compared with simvastatin (40 mg) and placebo (simvastatin monotherapy). The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke. The median follow-up was 6 years.
RESULTS: The median time-weighted average LDL cholesterol level during the study was 53.7 mg per deciliter (1.4 mmol per liter) in the simvastatin-ezetimibe group, as compared with 69.5 mg per deciliter (1.8 mmol per liter) in the simvastatin-monotherapy group (P
CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol levels and improved cardiovascular outcomes. Moreover, lowering LDL cholesterol to levels below previous targets provided additional benefit. (Funded by Merck; IMPROVE-IT ClinicalTrials.gov number, NCT00202878.).
Volume
372
Issue
25
First Page
2387
Last Page
2397
ISSN
1533-4406
Published In/Presented At
Cannon, C. P., Blazing, M. A., Giugliano, R. P., McCagg, A., White, J. A., Theroux, P., Darius, H., Lewis, B. S., Ophuis, T. O., Jukema, J. W., De Ferrari, G. M., Ruzyllo, W., De Lucca, P., Im, K., Bohula, E. A., Reist, C., Wiviott, S. D., Tershakovec, A. M., Musliner, T. A., Braunwald, E., … IMPROVE-IT Investigators (2015). Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. The New England journal of medicine, 372(25), 2387–2397. https://doi.org/10.1056/NEJMoa1410489
Disciplines
Medicine and Health Sciences
PubMedID
26039521
Department(s)
Department of Medicine, Cardiology Division
Document Type
Article