(HealthDay News) — Lipid-lowering therapy with ezetimibe plus simvastatin is associated with improved clinical outcomes, with a reduction in total primary end point events, according to a study published in the Journal of the American College of Cardiology.

Noting that ezetimibe/simvastatin therapy in the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) significantly reduced the first primary end points in patients after acute coronary syndromes, Sabina A. Murphy, MPH, from Brigham and Women’s Hospital in Boston, and colleagues examined whether total primary end point events would also be reduced. They examined all primary end point events during a median of 6 years of follow-up in 18 144 patients randomized to ezetimibe/simvastatin (Vytorin) or placebo/simvastatin (Zocor).

The researchers found that there were 9545 total primary end point events (56% first events; 44% subsequent events). Compared with placebo/simvastatin, there was a reduction in total primary end point events with ezetimibe/simvastatin (incidence-rate ratio [RR], 0.91; P=.007), and reductions in the 3 prespecified secondary composite end points and the exploratory composite end point of cardiovascular death, myocardial infarction, or stroke (RR, 0.88; P = 0.002). Decreases in total nonfatal myocardial infarction and total nonfatal stroke drove the reduction in total events (RRs, 0.87 [P=.004] and 0.77 [P=.005], respectively).

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“These data support continuation of intensive combination lipid-lowering therapy after an initial [cardiovascular] event,” the researchers wrote.

Several authors disclosed financial ties to biopharmaceutical companies, including Merck, which manufactures ezetimibe/simvastatin and funded the IMPROVE-IT study.


  1. Murphy SA, Cannon CP, Blazing MA, et al. Reduction in Total Cardiovascular Events With Ezetimibe/Simvastatin Post-Acute Coronary Syndrome: The IMPROVE-IT Trial. J Am Coll Cardiol. 2016;67(4):353-361. doi:10.1016/j.jacc.2015.10.077.