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Moderate-Intensity Statin With Ezetimibe vs High-Intensity Statin in Patients With Diabetes and Atherosclerotic CVD
TAKE-HOME MESSAGE
- This prespecified subgroup analysis compared the effect of combined ezetimibe and moderate-intensity statin therapy with that of high-intensity statin monotherapy in a cohort of 1398 patients with diabetes mellitus and atherosclerotic cardiovascular disease from the RACING trial. At 3 years, the incidence of cardiovascular death, major adverse cardiovascular events, and nonfatal stroke was not significantly different between the groups; however, the rate of intolerance-related drug discontinuation or dose reduction was lower and the proportion of patients achieving LDL-C levels <70 mg/dL was higher in the ezetimibe combination therapy group than in the high-intensity statin monotherapy group.
- Among patients with diabetes and atherosclerosis, ezetimibe plus moderate-intensity statin therapy is a safe and effective alternative to high-intensity statin monotherapy for the secondary prevention and management of dyslipidemia.
abstract
This abstract is available on the publisher's site.
Access this abstract nowAIMS
This study evaluated the effect of moderate-intensity statin with ezetimibe combination therapy vs. high-intensity statin monotherapy among patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD).
METHODS AND RESULTS
This was a pre-specified, stratified subgroup analysis of the DM cohort in the RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe combination therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95% confidence interval: 0.64-1.22; P = 0.460). Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in each group, respectively (P = 0.014). LDL cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%, 83.1%, and 79.9% of patients in the ezetimibe combination therapy group, and 64.1%, 70.2%, and 66.8% of patients in the high-intensity statin monotherapy group (all P < 0.001). In the total population, no significant interactions were found between DM status and therapy regarding primary outcome, intolerance-related discontinuation or dose reduction, and the proportion of patients with LDL cholesterol levels <70 mg/dL.
CONCLUSION
Ezetimibe combination therapy effects observed in the RACING trial population are preserved among patients with DM. This study supports moderate-intensity statin with ezetimibe combination therapy as a suitable alternative to high-intensity statins if the latter cannot be tolerated, or further reduction in LDL cholesterol is required among patients with DM and ASCVD.
Additional Info
Moderate-intensity statin with ezetimibe vs. high-intensity statin in patients with diabetes and atherosclerotic cardiovascular disease in the RACING trial
Eur Heart J 2022 Dec 19;[EPub Ahead of Print], YJ Lee, JY Cho, SC You, YH Lee, KH Yun, YH Cho, WY Shin, SW Im, WC Kang, Y Park, SY Lee, SJ Lee, SJ Hong, CM Ahn, BK Kim, YG Ko, D Choi, MK Hong, Y Jang, JS KimFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.