IMPROVE IT: Ezetimibe/Statin Combination Better After ACS Statin Alone
It has been a decade since Christopher Cannon, MD, Brigham and Women’s Hospital, Boston, Massachusetts presented the game-changing PROVE IT–TIMI 22 results at ACC.04 comparing intensive versus moderate lipid lowering with statins after acute coronary syndrome (ACS). Now, he is the lead author of IMPROVE-IT.
“This is the first trial to demonstrate an incremental clinical benefit when adding a non-statin cholesterol-lowering agent to a statin,” he said, “and we found that even lower was even better, reaffirming the LDL hypothesis that reducing LDL cholesterol prevents cardiovascular disease.”
IMPROVE-IT enrolled 18,144 patients with ACS and low-density lipoprotein (LDL) cholesterol levels <125 mg/dl or <100 if they were already using a statin. (About 5,000 had an ST-elevation MI and 13,000 a non-ST-elevation MI.) Patients also had at least one feature putting them at high risk for a further cardiovascular event, including a previous MI, diabetes, peripheral artery or cerebrovascular disease, coronary disease in multiple arteries, or bypass surgery in the past.
Compared to patients given simvastatin plus placebo, those receiving both simvastatin and ezetimibe had a 6.4% lower risk of all cardiovascular events (FIGURE), a 14% lower risk of MI, a 14% lower risk of stroke, and a 21% lower risk of ischemic stroke. There was no significant difference in mortality over the nearly 6 years of follow-up, with some patients followed for up to 8.5 years.
“The study affirms the central role of intensive LDL reduction in the prevention of recurrent cardiac events and expands the options for additional proven lipid-lowering therapies,” according to Neil Stone, MD, Northwestern University School of Medicine, Chicago, Illinois.