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. 2021 Apr;12(2):98-108.
doi: 10.14740/cr1224. Epub 2021 Feb 23.

Effect of Ezetimibe Added to High-Intensity Statin Therapy on Low-Density Lipoprotein Cholesterol Levels: A Meta-Analysis

Jayden Lee  1 , Ugochukwu Egolum  2 , Harish Parihar  3 , Michael Cooley  1 , Hua Ling  1
Affiliations

Effect of Ezetimibe Added to High-Intensity Statin Therapy on Low-Density Lipoprotein Cholesterol Levels: A Meta-Analysis

Jayden Lee et al. Cardiol Res. 2021 Apr.

Abstract

Background: Adding ezetimibe to high-intensity statin therapy is used for additional lowering of low-density lipoprotein cholesterol (LDL-C); however, there are little data on the efficacy of ezetimibe when combined with a high-intensity statin. A meta-analysis was performed to evaluate the efficacy of ezetimibe added to high-intensity statin therapy on LDL-C levels.

Methods: A literature search from database inception to May 2020 was performed using PubMed, EMBASE and Cochrane Central Register of Controlled Trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this meta-analysis, in which the random-effects model was adopted for the calculation of the mean difference (MD). The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the quality of the included trials.

Results: A total of 14 trials with 2,007 patients were included in this study. Compared to the high-intensity statin monotherapy, the MD in LDL-C reduction with high-intensity statin therapy plus ezetimibe was -14.00% (95% confidence interval: -17.78 to -10.22; P < 0.001) with a moderate degree of heterogeneity (P < 0.001, I2 = 66%). No significant publication bias among the included trials was identified.

Conclusions: Our study found that adding ezetimibe to high-intensity statin therapy provided a significant but attenuated incremental reduction in LDL-C levels. Whether the magnitude of this additional lowering of LDL-C levels would lead to benefits in clinical cardiovascular outcomes needs further investigation.

Keywords: Coronary heart disease; Ezetimibe; High-intensity statin; Hypercholesterolemia; LDL-C.

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Conflict of interest statement

None to declare.

Figures

Figure 1
Figure 1
Flowchart for study selection.
Figure 2
Figure 2
Risk of bias summary.
Figure 3
Figure 3
Forest plot of comparison: the mean difference in the reduction of LDL-C levels. LDL-C: low-density lipoprotein cholesterol.
See this image and copyright information in PMC

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