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Combination Lipid-Lowering Therapy After PCI
Quick Takes
- The current observational analysis assessed the clinical impact of the two strategies (moderate-intensity statin therapy/ezetimide compared to high-intensity statin monotherapy) among patients undergoing PCI in the Korean nationwide cohort database.
- Combination therapy was associated with a relative 25% reduction in the primary clinical endpoint at 3 years (cardiovascular death, MI, coronary artery revascularization, hospitalization for heart failure treatment, or nonfatal stroke) among patients undergoing PCI.
- Patients on combination therapy were less likely to discontinue statin therapy and had a lower occurrence of diabetes requiring treatment.
Study Questions:
What is the impact of lipid lowering with high-intensity statin monotherapy versus moderate-intensity statin/ezetimibe combination in clinical practice?
Methods:
After stabilized inverse probability of treatment weighting, a total of 72,050 patients who were prescribed rosuvastatin after drug-eluting stent (DES) implantation were identified from a nationwide cohort database: 10,794 patients with rosuvastatin 10 mg plus ezetimibe 10 mg (combination lipid-lowering therapy) and 61,256 patients with rosuvastatin 20 mg monotherapy. The primary endpoint was the 3-year composite event of cardiovascular death, myocardial infarction (MI), coronary artery revascularization, hospitalization for heart failure treatment, or nonfatal stroke.
Results:
Combination lipid-lowering therapy was associated with a lower occurrence of the primary endpoint (11.6% vs. 15.2% for those with high-intensity statin monotherapy; hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.70-0.79; p < 0.001). Compared to high-intensity statin monotherapy, combination lipid-lowering therapy was associated with fewer discontinuations of statin (6.5% vs. 7.6%; HR, 0.85; 95% CI, 0.78-0.94; p < 0.001) and a lower occurrence of new-onset diabetes requiring medication (7.7% vs. 9.6%; HR, 0.80; 95% CI, 0.72-0.88; p < 0.001).
Conclusions:
In clinical practice, combination lipid-lowering therapy with ezetimibe and moderate-intensity statin was associated with favorable clinical outcomes and drug compliance in patients treated with DES implantation.
Perspective:
The RACING trial was a randomized controlled trial (RCT), which showed noninferiority of combination moderate-intensity statin therapy/ezetimide compared to high-intensity statin monotherapy among patients with atherosclerotic cardiovascular disease. The current observational analysis assessed the clinical impact of the two strategies among patients undergoing PCI in the Korean nationwide cohort database. Combination therapy was associated with a relative 25% reduction in the primary clinical endpoint at 3 years (cardiovascular death, MI, coronary artery revascularization, hospitalization for heart failure treatment, or nonfatal stroke) among patients undergoing PCI. In addition, patients on combo therapy were less likely to discontinue statin therapy and had a lower occurrence of diabetes requiring treatment. Statin adherence remains a real concern in clinical practice with nearly 30% of patients discontinuing therapy due to side effects. Current findings, though limited by the observational study design, lend support to the use of combination moderate-intensity statin/ezetimide therapy to increase adherence, reduce clinical events, and possibly reduce risk of new-onset diabetes mellitus requiring therapy compared to high-intensity statin dosing. A RCT in a broader population will be needed to confirm these findings.
Clinical Topics: Cardiac Surgery, Diabetes and Cardiometabolic Disease, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and Heart Failure, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Interventions and Coronary Artery Disease
Keywords: Atherosclerosis, Coronary Artery Disease, Diabetes Mellitus, Drug-Eluting Stents, Dyslipidemias, Ezetimibe, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Medication Adherence, Myocardial Infarction, Myocardial Revascularization, Percutaneous Coronary Intervention, Rosuvastatin Calcium, Secondary Prevention, Stroke
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