Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT. et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;139(25):e1082–e1143. doi: 10.1161/CIR.0000000000000698. - DOI - PMC - PubMed
    1. Gencer B, Carballo D, Nanchen D, Koskinas KC, Klingenberg R, Raber L, Auer R. et al. Intensified lipid lowering using ezetimibe after publication of the IMPROVE-IT trial: A contemporary analysis from the SPUM-ACS cohort. Int J Cardiol. 2020;303:8–13. doi: 10.1016/j.ijcard.2019.12.011. - DOI - PubMed
    1. Cannon CP, Blazing MA, Giugliano RP, McCagg A, White JA, Theroux P, Darius H. et al. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015;372(25):2387–2397. doi: 10.1056/NEJMoa1410489. - DOI - PubMed
    1. Mikhailidis DP, Sibbring GC, Ballantyne CM, Davies GM, Catapano AL. Meta-analysis of the cholesterol-lowering effect of ezetimibe added to ongoing statin therapy. Curr Med Res Opin. 2007;23(8):2009–2026. doi: 10.1185/030079907X210507. - DOI - PubMed
    1. Mikhailidis DP, Lawson RW, McCormick AL, Sibbring GC, Tershakovec AM, Davies GM, Tunceli K. Comparative efficacy of the addition of ezetimibe to statin vs statin titration in patients with hypercholesterolaemia: systematic review and meta-analysis. Curr Med Res Opin. 2011;27(6):1191–1210. doi: 10.1185/03007995.2011.571239. - DOI - PubMed

LinkOut - more resources