Is it associated with additional low-density lipoprotein cholesterol reduction benefits?
Main Takeaway
Low-density lipoprotein cholesterol (LDL-C) was further reduced by 31.0–41.0% after switching from a statin monotherapy to a statin plus ezetimibe therapy
- Among the total enrolled patients, 88.3–90.1% of the patients successfully attained the target LDL-C goal of <100 mg/dL (all intensity groups, P <0.01)
Why This Matters
Though intense LDL-C management is recommended in order to attain desired targets, the percentage of patients attaining the target LDL-C remains substantially low
- This real-world study evaluated the effect of switching from statin monotherapy to statin/ezetimibe combination therapy in terms of target LDL-C goals attained
Study Design
Retrospective study: electronic medical records of 4,252 patients from two Korean tertiary care medical centers (1 January 2015 - 31 December 2017)
- Six statin/ezetimibe combinations were assessed: – Atorvastatin 10 mg plus ezetimibe 10 mg – Atorvastatin 20 mg plus ezetimibe 10 mg – Atorvastatin 40 mg plus ezetimibe 10 mg – Rosuvastatin 5 mg plus ezetimibe 10 mg – Rosuvastatin 10 mg plus ezetimibe 10 mg – Rosuvastatin 20 mg plus ezetimibe 10 mg
Study outcomes: LDL-C reductions; percentage of patients attaining LDL-C levels of <100 mg/dL after 3 months of combination treatment (vs baseline values)
Key Results
Effect of combination therapy on LDL-C levels after 3 months of treatment (vs baseline):
- Atorvastatin 10 mg plus ezetimibe or rosuvastatin 5 mg plus ezetimibe:
- LDL-C level reduction = 31.0% (P <0.01)
- Patients attaining LDL-C target (<100 mg/dL) = 88.3% vs 35.3% at baseline (P <0.01)
- Atorvastatin 20 mg plus ezetimibe or rosuvastatin 10 mg plus ezetimibe:
- LDL-C level reduction = 36.4% (P <0.01)
- Patients attaining LDL-C target = 90.1% vs 33.4% at baseline (P <0.01)
- Atorvastatin 40 mg plus ezetimibe or rosuvastatin 20 mg plus ezetimibe:
- LDL-C level reduction = 41.0% (P <0.01)
- Patients attaining LDL-C target = 87.5% vs 21.9% at baseline (P <0.01)
Switching from statin monotherapy to rosuvastatin plus ezetimibe exhibited greater LDL-C reductions than atorvastatin plus ezetimibe
- Patients switching from a low-intensity statin to combination therapy:
- Atorvastatin (10, 20 mg) plus ezetimibe = 40.9%, 48.7%
- Rosuvastatin (5, 10 mg) plus ezetimibe = 49.2%, 51.8%
- Patients switching from a moderate-intensity statin to combination therapy:
- Atorvastatin (10, 20, 40 mg) plus ezetimibe = 32.8%, 36.1%, 37.3%
- Rosuvastatin (5, 10, 20 mg) plus ezetimibe = 29.3%, 38.7%, 45.8%
- Patients switching from a high-intensity statin to combination therapy:
- Atorvastatin (10, 20, 40 mg) plus ezetimibe = 12.4%, 27.6%, 37.4%
- Rosuvastatin (5, 10, 20 mg) plus ezetimibe = 24.1%, 30.6%, 37.4%
Limitations
- This study had the inherent limitations of retrospective studies, lacked information regarding patient adherence, and did not evaluate adverse effects
- The percentages of patients attaining target LDL-C levels (<100 mg/dL) was calculated without classifying their risk factors
MAT-QA-2100065/v1/Oct 2021