Safety and Effectiveness of High-Intensity Statins Versus Low/Moderate-Intensity Statins Plus Ezetimibe in Patients With Atherosclerotic Cardiovascular Disease for Reaching LDL-C Goals: A Systematic Review and Meta-Analysis

IF 2.4 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Clinical Cardiology Pub Date : 2024-08-12 DOI:10.1002/clc.24334

Hamidreza Soleimani, Asma Mousavi, Shayan Shojaei, Kiarash Tavakoli, Dorsa Salabat, Farid Farahani Rad, Mani K. Askari, John Nelson, Mohammad Ruzieh, Kaveh Hosseini

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Abstract

Background

It remains controversial whether adding ezetimibe to low/moderate-intensity statins has a more beneficial impact on the treatment efficacy and safety of patients with existing atherosclerotic cardiovascular disease (ASCVD) compared to high-intensity statin regimens.

Hypothesis

A combination of low/moderate-intensity statins plus ezetimibe might be more effective and safer than high-intensity statin monotherapy.

Methods

We searched databases for randomized controlled trials comparing lipid profile alterations, drug-related adverse events, and MACE components between high-intensity statin monotherapy and low/moderate-intensity statin plus ezetimibe combination therapy. Pooled risk ratios (RR), mean differences (MD), and 95% confidence intervals (95% CI) were estimated using a random-effects model.

Results

Our comprehensive search resulted in 32 studies comprising 6162 patients treated with monotherapy against 5880 patients on combination therapy. Combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels compared to monotherapy (MD = −6.6, 95% CI: −10.6 to −2.5); however, no significant differences were observed in other lipid parameters. Furthermore, the combination therapy group experienced a lower risk of myalgia (RR = 0.27, 95% CI: 0.13–0.57) and discontinuation due to adverse events (RR = 0.61, 95% CI: 0.51–0.74). The occurrence of MACE was similar between the two treatment groups.

Conclusions

Adding ezetimibe to low/moderate-intensity statins resulted in a greater reduction in LDL-C levels, a lower rate of myalgia, and less drug discontinuation compared to high-intensity statin monotherapy in patients with existing cardiovascular disease. However, according to our meta-analysis, the observed reduction in LDL-C levels in the combination group did not correlate with a reduction in MACE compared to the high-intensity statin group.

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高强度他汀类药物与低/中强度他汀类药物加依折麦布对动脉粥样硬化性心血管疾病患者达到低密度脂蛋白胆固醇目标的安全性和有效性：系统回顾与元分析》。

背景：与高强度他汀类药物治疗方案相比，在低/中强度他汀类药物中添加依折麦布是否会对现有动脉粥样硬化性心血管疾病（ASCVD）患者的治疗效果和安全性产生更有利的影响，目前仍存在争议：假设：与高强度他汀单一疗法相比，低/中强度他汀联合依折麦布可能更有效、更安全：我们检索了数据库中的随机对照试验，比较了高强度他汀类药物单药治疗与低/中强度他汀类药物加依折麦布联合治疗之间的血脂谱改变、药物相关不良事件和MACE成分。采用随机效应模型估算了汇总风险比（RR）、平均差（MD）和 95% 置信区间（95% CI）：通过全面搜索，我们发现了 32 项研究，包括 6162 名接受单一疗法治疗的患者和 5880 名接受联合疗法治疗的患者。与单一疗法相比，联合疗法在降低低密度脂蛋白胆固醇（LDL-C）水平方面更有效（MD = -6.6，95% CI：-10.6 至 -2.5）；但在其他血脂参数方面未观察到显著差异。此外，联合疗法组发生肌痛（RR = 0.27，95% CI：0.13-0.57）和因不良事件而停药（RR = 0.61，95% CI：0.51-0.74）的风险较低。两个治疗组的MACE发生率相似：结论：与高强度他汀类药物单药治疗相比，在低/中强度他汀类药物中添加依折麦布可使现有心血管疾病患者的低密度脂蛋白胆固醇水平降低更多，肌痛发生率更低，停药率更低。然而，根据我们的荟萃分析，与高强度他汀类药物组相比，联合用药组观察到的 LDL-C 水平降低与 MACE 的减少并不相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Cardiology 医学-心血管系统

CiteScore

5.10

自引率

3.70%

发文量

189

审稿时长

4-8 weeks

期刊介绍： Clinical Cardiology provides a fully Gold Open Access forum for the publication of original clinical research, as well as brief reviews of diagnostic and therapeutic issues in cardiovascular medicine and cardiovascular surgery. The journal includes Clinical Investigations, Reviews, free standing editorials and commentaries, and bonus online-only content. The journal also publishes supplements, Expert Panel Discussions, sponsored clinical Reviews, Trial Designs, and Quality and Outcomes.