Comparative efficacy of different statin intensities combined with ezetimibe on lipid profile improvement in patients with coronary heart disease: A network meta-analysis

IF 6.9 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2026-09-01 Epub Date: 2026-07-15 DOI:10.1016/j.jacl.2026.07.017

Qingsheng Niu MD, Peng Yao MD, PhD, Lu Gan MD, PhD, Ling Wang MS, Yaowen Jiang MD, Yu Cao MD, PhD

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Abstract

BACKGROUND

Despite statin medication, a substantial number of patients with coronary heart disease (CHD) do not meet guideline-recommended lipid goals, increasing dependence on combination lipid-lowering methods. However, evidence comparing the lipid-modifying effectiveness of ezetimibe added to statins of varying intensities is lacking, creating confusion about the best treatment options in clinical practice. This research sought to assess and compare the effectiveness of statins of varying intensities in conjunction with ezetimibe for enhancing lipid profiles in individuals with CHD.

SOURCES OF MATERIAL

PubMed, Embase, Cochrane Library, and Web of Science were searched to January 1, 2026 for randomized controlled trials (RCTs) comparing statin monotherapy with statin-ezetimibe therapy in CHD. Network meta-analysis was performed using Stata 17.0, with surface under the cumulative ranking curve-based ranking. Outcomes were low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), total cholesterol (TC), non–HDL-C, and apolipoprotein B (ApoB).

ABSTRACT OF FINDINGS

A total of 38 RCTs involving 7340 patients with CHD were included. Network meta-analyses demonstrated that moderate-intensity statin (MIS) therapy coupled with ezetimibe regularly resulted in significant enhancements in LDL-C, HDL-C, TC, non-HDL-C, and ApoB levels. For LDL-C reduction, MIS plus ezetimibe was comparable in efficacy to a high-intensity statin (HIS) plus ezetimibe. For TG, HIS combined with ezetimibe was rated highest, while no significant change was noted in comparison to MIS combined with ezetimibe. Rosuvastatin plus ezetimibe may demonstrate the greatest efficacy among MIS-based combination regimens.

CONCLUSION

Adding ezetimibe to MIS medication in patients with CHD provides a more balanced cholesterol-lowering strategy than statin dosage increase alone, with effectiveness equivalent to HIS-based treatment across several lipid measures.

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不同剂量的他汀类药物联合依折替米贝对冠心病患者血脂改善的比较疗效：一项网络荟萃分析

背景：尽管服用了他汀类药物，但仍有相当数量的冠心病（CHD）患者不能达到指南推荐的血脂目标，这增加了对联合降脂方法的依赖。然而，比较依zetimibe加入不同强度他汀类药物的降脂效果的证据缺乏，这在临床实践中造成了对最佳治疗方案的混淆。本研究旨在评估和比较不同剂量的他汀类药物与依折麦布联合用于提高冠心病患者血脂水平的有效性。资料来源：PubMed、Embase、Cochrane Library和Web of Science检索到2026年1月1日的随机对照试验（rct），比较他汀类药物单药治疗和他汀-依泽可米治疗冠心病的疗效。采用Stata 17.0进行网络meta分析，以累积排名曲线下的面为基础进行排名。结果为低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、甘油三酯（TG）、总胆固醇（TC）、非HDL-C和载脂蛋白B （ApoB）。研究结果摘要：共纳入38项随机对照试验，涉及7340例冠心病患者。网络荟萃分析表明，中等强度的他汀类药物（MIS）联合依zetimibe定期可显著提高LDL-C、HDL-C、TC、非HDL-C和ApoB水平。对于降低LDL-C， MIS加依折麦比的疗效与高强度他汀类药物（HIS）加依折麦比相当。对于TG， HIS联合依折麦布评分最高，而与MIS联合依折麦布相比没有明显变化。瑞舒伐他汀加依折替贝可能在以mis为基础的联合方案中显示出最大的疗效。结论：与单独增加他汀类药物剂量相比，在冠心病患者MIS药物中加入依折替米比提供了一种更平衡的降胆固醇策略，其效果相当于几种脂质测量中基于his的治疗。

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

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.