- 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).
- 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.
- Prespecified secondary analysis, randomised IMPROVE-IT trial, with 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.
- Generalisability not clear.