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Moderate-Intensity Statins Plus Ezetimibe vs. High-Intensity Statins After Coronary Revascularization: A Cohort Study

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Abstract

Purpose

Whether moderate-intensity statins plus ezetimibe could be an alternative to high-intensity statins in patients with atherosclerotic cardiovascular disease is unclear. We compared the risk of adverse cardiovascular events in patients receiving moderate-intensity statins plus ezetimibe vs. high-intensity statins after a coronary revascularization procedure using data from a large cohort study.

Method

Population-based cohort study using nationwide medical insurance data from Korea. Study participants (n = 20,070) underwent percutaneous coronary intervention or coronary artery bypass graft surgery between January 1, 2015, and December 31, 2016, and received moderate-intensity statins (atorvastatin 10–20 mg or rosuvastatin 5–10 mg) plus ezetimibe (n = 922) or high-intensity statins (atorvastatin 40–80 mg or rosuvastatin 20 mg; n = 19,148). The primary outcome was a composite of cardiovascular mortality, hospitalization for myocardial infarction (MI), hospitalization for stroke, or revascularization.

Results

At 12 months, the incidence rates of the primary outcome were 138.0 vs. 154.0 per 1000 person-years in the moderate-intensity stains plus ezetimibe and the high-intensity statins group, respectively. The fully adjusted hazard ratio [HR] for the primary outcome was 1.11 (95% confidence interval [CI] 0.86–1.42; p = 0.43). The multivariable-adjusted HR for a composite of cardiovascular mortality, hospitalization for MI, or hospitalization for stroke was 1.05 (95% CI 0.74–1.47; p = 0.80). During follow-up, the proportion of patients maintaining their initial lipid-lowering therapy was significantly higher in the moderate-intensity statins plus ezetimibe group than in the high-intensity statins group.

Conclusions

Patients undergoing a coronary revascularization procedure who received moderate-intensity statins plus ezetimibe showed similar rates of major adverse cardiovascular events as patients who received high-intensity statins.

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Data Availability

The data that support the finding of this study are available from the corresponding author upon reasonable request.

Code Availability

Not applicable.

Abbreviations

ACE:

Angiotensin-converting enzyme

ARB:

Angiotensin II receptor blocker

ASCVD:

Atherosclerotic cardiovascular disease

CABG:

Coronary artery bypass graft surgery

ICD:

International Classification of Diseases

IPTW:

Inverse probability of treatment weighting

LDL-C:

Low-density lipoprotein cholesterol

MACE:

Major adverse cardiovascular event

MI:

Myocardial infarction

PCI:

Percutaneous coronary intervention

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Author notes

  1. Juwon Kim and Danbee Kang contributed equally to this paper.

Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Juwon Kim, Ki Hong Choi, Taek Kyu Park, Joo Myung Lee, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Seung-Hyuk Choi, Hyeon-Cheol Gwon & Joo-Yong Hahn

  2. Center for Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Danbee Kang, Hyejeong Park, Minwoong Kang, Eliseo Guallar & Juhee Cho

  3. Department of Clinical Research Design and Evaluation, SAIHST, Sungkyunkwan University, 81 Irwon-Ro, Gangnam-gu, Seoul, 06351, Republic of Korea

    Danbee Kang, Minwoong Kang, Eliseo Guallar & Juhee Cho

  4. Departments of Epidemiology and Medicine Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Eliseo Guallar

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  1. Juwon Kim
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Contributions

All authors contributed to the design, analysis, interpretation of data, drafting the article, and revising it critically for important intellectual content and approved the final version of the manuscript.

Corresponding authors

Correspondence to Juhee Cho or Joo-Yong Hahn.

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Ethics Approval

The Institutional Review Board of the Samsung Medical Center approved this study and waived the requirement for informed consent because we only accessed de-identified previously collected data.

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Given by all co-authors.

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The authors declare no competing interests.

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Kim, J., Kang, D., Park, H. et al. Moderate-Intensity Statins Plus Ezetimibe vs. High-Intensity Statins After Coronary Revascularization: A Cohort Study. Cardiovasc Drugs Ther 37, 141–150 (2023). https://doi.org/10.1007/s10557-021-07256-1

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