Comparative cardiovascular outcomes of statin monotherapy versus statin plus ezetimibe combination therapy in patients with atherosclerotic cardiovasc

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.024

M Kenan Rahima MD, Fernando Faxas MD, Kayode Oguniyi MD, Muayad Alzamara MD, Godbless Ajenaghughrure MD

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Abstract

Background/Synopsis

The optimal lipid-lowering strategy for patients with atherosclerotic cardiovascular disease (ASCVD) remains debated. While statins are the cornerstone of therapy, the additional benefit of ezetimibe in real-world settings needs further investigation.

Objective/Purpose

To compare the clinical outcomes of patients with atherosclerotic cardiovascular disease (ASCVD) who were treated with statin monotherapy versus those treated with statin plus ezetimibe combination therapy in a real-world setting.

Methods

Using the TriNetX global federated health research network comprising 104 healthcare organizations, we conducted a retrospective cohort study comparing patients on statin monotherapy (n=119,338) versus statin plus ezetimibe (n=119,338) after propensity score matching. All patients had established ASCVD and LDL-C ≥ 70 mg/dL. The primary outcomes included death, cardiovascular events, and neurological outcomes over a 5-year follow-up period.

Results

After propensity score matching, baseline characteristics including hypertension (85.4% vs 85.3%), diabetes (46.3% vs 46.3%), and prior myocardial infarction (29.8% vs 29.6%) were well-balanced between groups. The statin plus ezetimibe group showed significantly lower risk across multiple outcomes compared to statin monotherapy: all-cause mortality (HR 1.445, 95% CI 1.412-1.480), dementia (HR 1.498, 95% CI 1.447-1.550), cardiac arrest (HR 1.332, 95% CI 1.263-1.404), and stroke (HR 1.253, 95% CI 1.202-1.306). More modest risk reductions were observed for atrial fibrillation (HR 1.132, 95% CI 1.110-1.154) and heart failure (HR 1.075, 95% CI 1.059-1.091), while ventricular tachycardia showed no significant difference between groups (HR 1.035, 95% CI 0.999-1.072).

Conclusions

In this large real-world study of ASCVD patients, combination therapy with statin plus ezetimibe was associated with significantly lower risks of mortality and major cardiovascular outcomes compared to statin monotherapy. These findings support the increased use of combination therapy in high-risk patients with ASCVD

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他汀类药物单药治疗与他汀+依折麦布联合治疗在动脉粥样硬化性心血管患者中的心血管预后比较

背景/简介动脉粥样硬化性心血管疾病（ASCVD）患者的最佳降脂策略仍存在争议。虽然他汀类药物是治疗的基石，但依折麦布在现实环境中的额外益处需要进一步研究。目的/目的在现实环境中比较他汀类药物单药治疗与他汀类药物加依折麦布联合治疗的动脉粥样硬化性心血管疾病（ASCVD）患者的临床结果。方法使用TriNetX全球联合健康研究网络，包括104个医疗机构，我们进行了一项回顾性队列研究，比较倾向评分匹配后他汀类药物单药治疗（n=119,338）和他汀类药物加依折替贝（n=119,338）的患者。所有患者均有ASCVD，且LDL-C≥70 mg/dL。主要结局包括5年随访期间的死亡、心血管事件和神经系统结局。结果倾向评分匹配后，基线特征包括高血压（85.4% vs 85.3%）、糖尿病（46.3% vs 46.3%）和既往心肌梗死（29.8% vs 29.6%）在组间平衡良好。与他汀类药物单药治疗相比，他汀类药物加依泽替米贝组在多个结局中的风险显著降低：全因死亡率（HR 1.445, 95% CI 1.412-1.480）、痴呆（HR 1.498, 95% CI 1.447-1.550）、心脏骤停（HR 1.332, 95% CI 1.263-1.404）和中风（HR 1.253, 95% CI 1.202-1.306）。房颤（HR 1.132, 95% CI 1.110-1.154）和心力衰竭（HR 1.075, 95% CI 1.059-1.091）的风险降低较为温和，而室性心动过速组间无显著差异（HR 1.035, 95% CI 0.999-1.072）。结论：在这项针对ASCVD患者的大型现实世界研究中，与他汀类药物单药治疗相比，他汀类药物加依折替贝联合治疗的死亡率和主要心血管结局风险显著降低。这些发现支持在ASCVD高危患者中增加联合治疗的使用

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.