Impact of Lipid-Lowering Combination Therapy With Statins and Ezetimibe vs Statin Monotherapy on the Reduction of Cardiovascular Outcomes: A Meta-analysis
Banach M, Jaiswal V, Ang SP, Sawhney A, Deb N, Amarenco P, Gaita D, Reiner Z, Pećin I, Lavie CJ, Penson PE, Toth PP, Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group and the International Lipid Expert Panel (ILEP)
Mayo Clinic proceedings · 24 citas
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Cómo se estudió
- Diseño
- Metaanálisis (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 2025-03-23 · Mayo Clin Proc · vol. 100 · número 12 · págs. 2152–2171
- Editorial
- Elsevier BV
- Citado
- 21 citas · más que el 99% de estudios similares · 6.7× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 73 trabajos
- Acceso
- De pago
- Áreas de investigación
- Lipoproteins and Cardiovascular Health · Cancer, Lipids, and Metabolism · Blood Pressure and Hypertension Studies
- Palabras clave
- statins, ezetimibe, combination lipid-lowering therapy, LDL cholesterol lowering, major adverse cardiovascular events, all-cause mortality, stroke, cardiovascular mortality, very high-risk patients, hypercholesterolemia, adverse drug reactions, treatment discontinuation, LDL-C goal attainment, cardiovascular disease prevention, secondary prevention
- MeSH
- humans, cardiovascular diseases, anticholesteremic agents, hydroxymethylglutaryl-coa reductase inhibitors, treatment outcome, drug therapy, combination, cholesterol, ldl, ezetimibe
12 autores
- Maciej Banach🇵🇱🇺🇸🇬🇧 · autor de correspondenciaJohn Paul II Catholic University of Lublin; Johns Hopkins University; University of Liverpool; Medical University of Lodz; Polish Mother’s Memorial Hospital Research Institute
- Vikash Jaiswal🇺🇸Larkin Community Hospital
- Song Peng Ang🇺🇸Community Medical Center; Rutgers Health
- Aanchal Sawhney🇺🇸Crozer-Keystone Health System
- Novonil Deb🇮🇳North Bengal Medical College and Hospital
- Pierre Amarenco🇫🇷Assistance Publique – Hôpitaux de Paris; Hôpital Bichat-Claude-Bernard
- Dan Ion Gaiță
- Željko Reiner🇭🇷🇵🇱University Hospital Centre Zagreb; Polish Mother’s Memorial Hospital Research Institute
- Ivan Pećin🇭🇷University of Zagreb
- Carl J. Lavie🇦🇺🇺🇸The University of Queensland; Ochsner Medical Center
- Peter Edward Penson🇬🇧Liverpool John Moores University
- Peter Paul Toth🇺🇸Johns Hopkins University; CGH Medical Center
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
To evaluate the efficacy of combination lipid-lowering therapy (LLT) compared with statin monotherapy for low-density lipoprotein cholesterol (LDL-C) reduction, associated adverse events, and outcomes.
Methods
A systematic literature search was conducted using PubMed, Embase, and ClinicalTrials.gov to identify relevant articles published from inception until the end of June 2024. The outcomes were assessed using pooled odds ratios (ORs) for categorical data and mean difference for continuous data, with corresponding 95% CIs.
Results
A total of 14 studies (11 randomized controlled trials and 3 cohort studies) with 108,373 very high-risk patients were included in the final analysis. The mean age of the patients in the combination LLT group and the statin monotherapy group was 67.31 and 67.89 years, respectively. Pooled analysis revealed that combination LLT significantly more effectively reduced the LDL-C level from baseline (mean difference, -12.96 mg/dL; 95% CI, -17.27 to -8.65; P<.001) and significantly reduced all-cause mortality (OR, 0.81; 95% CI, 0.67 to 0.97; P=.02), major adverse cardiovascular events (OR, 0.82; 95% CI, 0.69 to 0.97; P=.02), and stroke incidence (OR, 0.83; 95% CI, 0.75 to 0.91; P<.001), with an insignificant effect on cardiovascular mortality (OR, 0.86; 95% CI, 0.65 to 1.12; P=.26) when compared with statin monotherapy. The risk of adverse events and the therapy discontinuation rate were comparable between groups.
Conclusion
Combination LLT was associated with an overall greater reduction in LDL-C, the same risk of adverse effects, and significantly lower risk of all-cause mortality, major adverse cardiovascular events, and stroke compared with statin monotherapy. Forthcoming guidelines should consider the lipid-lowering combination therapy as early as possible, preferably up-front, for more effective LDL-C goal achievement and significant reduction of cardiovascular disease outcomes and mortality in high- and very high-risk patients.
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