Ezetimibe-simvastatin combo yields reduced CVD events in older patients

  • Bach RG & al.
  • JAMA Cardiol
  • 17 Jul 2019

  • International Clinical Digest
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Takeaway

  • Ezetimibe-simvastatin (Vytorin) in patients hospitalised for acute coronary syndrome beats simvastatin monotherapy for secondary prevention, especially in patients aged 75 years or older.

Why this matters

  • Editorial: analysis bridges an “important gap”, with results offering strong support for intensive lipid-lowering therapy in older patients with atherosclerotic cardiovascular disease (CVD).

Key results

  • Increasing age was associated with steeper CVD event rate decreases with combination vs monotherapy:
    •  
    • 65-74 years: 35.9% vs 35.1%; and
    • 75+ years: 47.6% vs 38.9%.
  • Vs statin monotherapy+placebo, combination treatment was linked to reduced CVD-related event risk (HRs; 95% CIs) across age groups:
    • 65-74 years: 0.96 (0.87-1.06); 
    • 75+ years: 0.80 (0.70-0.90); and
    • P=.02, treatment-age interaction.
  • Number needed to treat for 1 ischaemic event reduction,  
    • 125 (95% CI, 113-∞) vs 11 (95% CI, 8-23).
  • No between-treatment differences for all-cause death.
  • Sensitivity analysis: mixed results for age-treatment interaction.
  • Safety events similar between combination and monotherapy.

Study design

  • Prespecified secondary analysis, randomised IMPROVE-IT trialwith 18,144 patients, mean age of 64.1 years at enrollment.
  • Main outcome: composite of CVD death, myocardial infarction, stroke, unstable angina requiring hospitalisation, coronary revascularisation after 30 days.
  • Funding: Merck & Co., Inc., Kenilworth, NJ, USA.

Limitations

  • Generalisability not clear.

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