The efficacy and safety of statin in combination with ezetimibe compared with double-dose statin in patients with high cardiovascular risk: A meta-analysis

  • Yunyun Zhu Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Haochang Hu Cardiovascular Department, Ningbo First Hospital, Zhejiang, China https://orcid.org/0000-0003-3798-1773
  • Jun Yang Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Qi Yao Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Hongyu Xu Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Yushan Yu Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Ting Liu Geriatrics Department, Ningbo First Hospital, Zhejiang, China
  • Shaoyi Lin Cardiovascular Department, Ningbo First Hospital, Zhejiang, China
Keywords: Efficacy, safety, statin, ezetimibe, high cardiovascular risk, combination therapy, low-density lipoprotein cholesterol, LDL-C, non-high-density lipoprotein cholesterol, non-HDL-C, total cholesterol, hypolipidemic

Abstract

Currently, statins are the first-line therapies for dyslipidemia and atherosclerotic cardiovascular disease, however, their hypolipidemic effects have not been satisfactory. We performed a meta-analysis to compare lipid-lowering efficacy and safety of ezetimibe and statin combination therapy with double-dose statin monotherapy in patients with high cardiovascular risk. Fourteen studies involving 3,105 participants were included in the final analysis; 1,558 (50.18%) participants received ezetimibe and statin combination therapy and 1,547 (49.82%) received double-dose statin monotherapy. Eight studies reported the percentages of changes in several lipid parameters from baseline to endpoint in both groups. Lipid parameters changed more significantly in patients co-administered with ezetimibe and statin (low-density lipoprotein cholesterol [LDL-C]: MD = -9.39, 95% CI -13.36 to -5.42; non-high-density lipoprotein cholesterol [non-HDL-C]: MD = -10.36, 95% CI -14.23 to -6.50; total cholesterol [TC]: MD = -8.11, 95% CI -10.95 to -5.26; and triglyceride [TG]: MD = -5.96, 95% CI -9.12 to -2.80), with moderate to high heterogeneity among the studies. Two out of fourteen studies investigated several different statins. Our subgroup analysis showed that, compared with double-dose atorvastatin monotherapy, ezetimibe and atorvastatin combination therapy significantly decreased LDL-C, non-HDL-C, TC, and TG levels by 14.16%, 14.01%, 11.06%, and 5.96%, respectively (p < 0.001). No significant difference was found in the incidence of laboratory-related adverse events (AEs) between statin combination therapy and monotherapy. Overall, ezetimibe and statin combination therapy significantly decreased LDL-C, non-HDL-C, and TC levels in patients with high cardiovascular risk, among which ezetimibe combined with atorvastatin had the best therapeutic effect. Compared with ezetimibe and statin combination therapy, double-dose statin monotherapy did not increase the risk of AEs.

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The efficacy and safety of statin in combination with ezetimibe compared with double-dose statin in patients with high cardiovascular risk: A meta-analysis
Published
2019-10-31
How to Cite
1.
Zhu Y, Hu H, Yang J, Yao Q, Xu H, Yu Y, Liu T, Lin S. The efficacy and safety of statin in combination with ezetimibe compared with double-dose statin in patients with high cardiovascular risk: A meta-analysis. Bosn J of Basic Med Sci [Internet]. 2019Oct.31 [cited 2019Nov.15];00. Available from: https://www.bjbms.org/ojs/index.php/bjbms/article/view/4437
Section
Reviews