Risk Stratification Tool IDs Patients With Acute Coronary Syndrome to Benefit From Ezetimibe

HealthDay News — For patients stabilized after acute coronary syndrome (ACS), a 9-point risk stratification tool can identify patients who will derive benefit from the addition of ezetimibe to statin therapy, according to a study published in the Journal of the American College of Cardiology.

Erin A. Bohula, MD, DPhil, from the Brigham and Women’s Hospital in Boston, and colleagues prospectively applied the 9-point Thrombolysis In Myocardial Infarction Risk Score for Secondary Prevention (TRS 2°P) stratification tool to 17,717 post-ACS patients randomized to ezetimibe and simvastatin or placebo and simvastatin in the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT).

For the integer-based scheme, the researchers observed a strong graded correlation between the rate of cardiovascular (CV) death/myocardial infarction (MI)/ischemic cerebrovascular accident (iCVA), the trial composite end points, and the individual components (P trend <.0001 for each). At 7 years, the absolute risk reduction in CV death/MI/iCVA was 6.3% for high-risk patients (defined by at least 3 risk indicators) taking ezetimibe/simvastatin, translating to a number-needed-to-treat of 16. The absolute risk reduction was 2.2% for intermediate-risk patients (2 risk indicators). There was no benefit from addition of ezetimibe for low-risk patients (0 or 1 indicator).

“Atherothrombotic risk stratification using the TRS 2°P identifies high-risk patients who derive greatest benefit from the addition of ezetimibe to statin therapy for secondary prevention after ACS,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Merck, which funded IMPROVE-IT.

References

Bohula EA, Morrow DA, Giugliano RP, et al. Atherothrombotic risk stratification and ezetimibe for secondary prevention. J Am Coll Cardiol. 2017;69(8):911-921. doi: 10.10169/j.jacc.2016.11.070

Schwartz GG. Who should receive ezetimibe? J Am Coll Cardiol. 2017;69(8):922-923. doi: 10.1016/j.jacc.2016.12.013