CV Benefit with Ezetmibe Add-On in Patients With Diabetes, ACS

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Ezetimibe added to statin therapy showed a benefit in patients with diabetes who were admitted to the hospital with acute coronary syndrome, according to a study presented the European Society of Cardiology Congress 2015.

The IMPROVE-IT trial (n=18,144) enrolled patients who were hospitalized with acute coronary syndrome (ACS) within the past 10 days, were not being treated with ezetimibe or the maximum dose of potent statins, and had LDL levels between 50–125mg/dL.

Study patients showed a further lowering of LDL cholesterol by 23–24%. Earlier studies had found that ezetimibe significantly reduced the relative risk of a future major cardiac or vascular event by 6.4% vs placebo. Treatment with ezetimibe was also found to lower the relative risk of having another major or cardiac or vascular event by 14% compared to patient who did not receive ezetimibe.

Cardiologists from the Brigham and Women's Hospital (BWH) and Duke Clinical Research Institute conducted a new analysis using data from the 27% of patients in the IMPROVE-IT trial who had diabetes at study initiation. For this population, ezetimibe when added to simvastatin, lowered LDL cholesterol by 43mg/dL after one year vs 23mg/dL with simvastatin alone.

This reduction in LDL led to reduced risks of future ischemic (non-bleeding) stroke by 39%, heart attack by 24%, and composite of death due to cardiovascular causes, including heart attack of stroke, by 20% compared with patients with diabetes who received statin therapy alone, reported Robert Giguliano, MD, senior investigator and cardiologist at BWH.

He added that the benefits conferred by ezetimibe were seen without an increase in liver test abnormalities, muscle side effects, gallbladder-related events, or cancer in patients with or without diabetes.

Reference

  1. Giugliano RP. #1947 "Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With vs Without Diabetes: the IMPROVE-IT Trial." Presented at: ESC Congress 2015; Aug. 30-Sept. 2, 2015; London, United Kingdom.
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