- 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.
- 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; moderate‐quality evidence.
- All-cause mortality not reduced with addition of ezetimibe to statin or fenofibrate (n=21,222; 8 studies; high‐quality evidence).
- Also the case with cardiovascular mortality (n=19,457; 6 studies; moderate‐quality evidence).
- Nonfatal MI reduced with ezetimibe+statin vs statin only:
- 0.88 (0.81-0.95; n=21,145; 6 studies; moderate‐quality evidence).
- Ditto nonfatal stroke:
- 0.83 (0.71-0.97; n=21,205; 6 studies; moderate‐quality evidence).
- Insufficient evidence to draw safety conclusions.
- 26 RCTs; n=23,499; follow-up at least 12 months.
- Funding: Northwestern University, National Institute for Health Research.
- The limitations of the included trials.