Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes.

Abstract (PubMed)

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. The combination of simvastatin (40 mg) and ezetimibe (10 mg) was compared with simvastatin (40 mg) and placebo. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization, or nonfatal stroke. RESULTS: The median follow-up was 6 years. The primary end point occurred in 32.7% of patients in the simvastatin-ezetimibe group versus 34.7% in the simvastatin-monotherapy group (hazard ratio, 0.936; 95% CI, 0.887–0.988; P=0.016). CONCLUSIONS: When added to statin therapy, ezetimibe resulted in incremental lowering of LDL cholesterol and improved cardiovascular outcomes.