3.4.0.0 Com­bi­na­tion Ther­a­py for LDL Choles­terol Low­er­ing

3.4.1.0 Statins and Eze­tim­ibe

The IM­Proved Re­duc­tion of Out­comes: Vy­torin Efficacy In­ter­na­tion­al Trial (IMPROVE-‍IT) was a ran­dom­ized con­trolled trial in 18,144 pa­tients com­par­ing the ad­di­tion of eze­tim­ibe to sim­vas­tatin ther­a­py ver­sus sim­vas­tatin alone. In­di­vid­u­als were ≥50 years of age, had ex­pe­ri­enced a re­cent acute coro­nary syn­drome (ACS), and were treat­ed for an av­er­a­ge ­of 6 years. Over­all, the ad­di­tion of eze­tim­ibe led to a 6.4% rel­a­tive benefit and a 2% ab­so­lute re­duc­tion in major ad­verse car­dio­vas­cu­lar events, with the de­gree of benefit being di­rectly pro­por­tion­al to the change in LDL choles­terol, which was 70 mg/dL in the statin group on av­er­age and 54 mg/dL in the com­bi­na­tion group (90). In those with di­a­betes (27% of par­tic­i­pants), the com­bi­na­tion of mod­er­ate-‍in­ten­si­ty sim­vas­tatin (40 mg) and eze­tim­ibe (10 mg) showed a significant re­duc­tion of major ad­verse car­dio­vas­cu­lar events with an ab­so­lute risk re­duc­tion of 5% (40% vs. 45% cu­mu­la­tive in­ci­dence at 7 years) and rel­a­tive risk re­duc­tion of 14% (haz­ard ratio [HR] 0.86 [95% CI 0.78–0.94]) over mod­er­ate-‍in­ten­si­ty sim­vas­tatin (40 mg) alone (94).