Ezetimibe offers modest protection against CVD events

  • Cochrane Database Sys Rev

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Ezetimibe (e.g., Zetia) offers modest benefit against cardiovascular disease (CVD)-related events, especially nonfatal myocardial infarction (MI) and nonfatal stroke.
  • This Cochrane review of 26 randomized controlled trials (RCTs), however, finds limited benefit regarding death-related endpoints.
  • Adverse event evidence is not sufficient, but evidence for benefit is moderate/high-quality.

Why this matters

  • CVD is one possible consequence of high cholesterol, and ezetimibe is a statin alternative for patients who cannot tolerate statins or who have maxed out statin dosage.

Key results

  • The largest included study was IMPROVE-IT , which largely drove the findings.
  • Major CVD events with ezetimibe+statin vs statins only (risk ratio [RR], 95% CIs):
    • 0.94 (0.90-0.98); n=21,727; 10 studies; moderatequality evidence.
  • All-cause mortality not reduced with addition of ezetimibe to statin or fenofibrate (n=21,222; 8 studies; highquality evidence).
  • Also the case with cardiovascular mortality (n=19,457; 6 studies; moderatequality evidence).
  • Nonfatal MI reduced with ezetimibe+statin vs statin only:
    • 0.88 (0.81-0.95; n=21,145; 6 studies; moderatequality evidence).
  • Ditto nonfatal stroke:
    • 0.83 (0.71-0.97; n=21,205; 6 studies; moderatequality evidence).
  • Insufficient evidence to draw safety conclusions.

Study design

  • 26 RCTs; n=23,499; follow-up at least 12 months.
  • Funding: Northwestern University, National Institute for Health Research.

Limitations

  • The limitations of the included trials.

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