High-Potency Statins, Not Ezetimibe, Benefit in Post-MI

July 15, 2014

DUNDEE, SCOTLAND — New data from a population-based study in the UK appears to support the latest recommendation that physicians use a potent statin in patients with established cardiovascular disease[1].

Publishing their findings February 19, 2014 in Heart, the researchers report that post-MI patients treated with a high-potency statin, such as atorvastatin or rosuvastatin (Crestor, AstraZeneca), had a statistically significant 28% lower risk of death when compared with simvastatin monotherapy over a mean follow-up of 3.2 years. For patients who received ezetimibe (Zetia, Merck/Schering-Plough) on top of simvastatin, there was no reduction in mortality.

Led by Dr Maheshwar Pauriah (University of Dundee, Scotland), the researchers state that just 274 of the 9597 patients were treated with ezetimibe/simvastatin. Given that 6990 patients were treated with simvastatin monotherapy and 1883 treated with rosuvastatin or atorvastatin, the study lacked statistical power to determine any mortality effect with ezetimibe.

"This would impact somewhat on the degree of confidence in concluding our neutral mortality benefit observed with an ezetimibe/statin combination," they report.

As reported by heartwire , the new American College of Cardiology (ACC) and American Heart Association (AHA) clinical guidelines on the treatment of cholesterol now recommend treating cardiovascular disease patients with a high-potency statin to achieve at least a 50% reduction in LDL-cholesterol levels. In addition to abandoning LDL targets, the new guidelines exclude the nonstatins, such as niacin, fibrates, and ezetimibe, unless the patient is statin intolerant or can't achieve the desired reduction in LDL cholesterol. Statins, however, are the frontline therapy for managing patient risk, according to the ACC/AHA.

Ezetimibe has been a controversial medication for many years now, with numerous outspoken critics saying the drug has never been proven to do anything beyond lower LDL-cholesterol levels. Physicians and patients will find out soon enough, though. The Improved Reduction of Outcomes: Vytorin Efficacy Internal Study (IMPROVE-IT), a trial testing the ezetimibe/simvastatin combination against simvastatin alone in acute coronary syndrome patients, is expected to be presented and published this year. The primary end point of the study is a composite of cardiovascular death, major coronary events, and stroke.

"Our study lends some support to the use of high-potency statins in survivors of myocardial infarction and raises questions regarding the use of adjunctive lipid-lowering therapy with ezetimibe," conclude Pauriah and colleagues. "However, we should await the results of the IMPROVE-IT study."

The authors have no conflicts of interest..



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