The short-term effect of atorvastatin plus ezetimibe therapy versus atorvastatin monotherapy on clinical outcome in acute coronary syndrome patients by gender

Abstract

Background: Atorvastatin reduces low-density lipoprotein cholesterol (LDL-C) levels and the risk of cardiovascular events, but whether the addition of ezetimibe (EZE), a non-statin drug that reduces intestinal cholesterol absorption, can reduce the rate of cardiovascular events further, and if there any sex differences, is not known.

Aim: To evaluate the effects of atorvastatin and EZE combination in acute coronary syndrome (ACS) patients on the incidence of composite endpoint in short-term follow-up and to assess differences according their gender.

Methods: We conducted a 16-week, single-centre, prospective, randomised, open-label clinical trial involving 323 patients who had been hospitalised for an ACS within the preceding 14 days. They received atorvastatin 20 mg for 28 days, and after that 292 patients who had LDL-C levels ≥ 1.81 mmol/L were randomised to EZE 10 mg/day co-administered with atorvastatin therapy (EZE + statin) or double their current atorvastatin dose. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalisation, coronary revascularisation (≥ 30 days after randomisation), or nonfatal stroke.

Results: The Kaplan-Meier event-free survival rate at 16 weeks was 88.1% in the EZE + statin group patients and 77.0% in the atorvastatin monotherapy group (absolute risk reduction: 11.1 percentage points; hazard ratio: 2.099; 95% confidence interval: 1.165-3.781; p = 0.014). The log rank test indicated that there was not a statistically significant difference between male and female survival rates in both treatment groups (p = 0.897).

Conclusions: The results of our study demonstrated that when added to statin therapy, EZE resulted in improved cardiovascular outcomes, and the response to atorvastatin and EZE combination was similar for both men and women.

Keywords: acute coronary syndrome; atorvastatin; ezetimibe; gender; low-density lipoprotein cholesterol.