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. 2023 Feb;37(1):141-150.
doi: 10.1007/s10557-021-07256-1. Epub 2021 Sep 17.

Moderate-Intensity Statins Plus Ezetimibe vs. High-Intensity Statins After Coronary Revascularization: A Cohort Study

Juwon Kim #  1 , Danbee Kang #  2   3 , Hyejeong Park  2 , Minwoong Kang  2   3 , Ki Hong Choi  1 , Taek Kyu Park  1 , Joo Myung Lee  1 , Jeong Hoon Yang  1 , Young Bin Song  1 , Jin-Ho Choi  1 , Seung-Hyuk Choi  1 , Hyeon-Cheol Gwon  1 , Eliseo Guallar  2   3   4 , Juhee Cho  5   6 , Joo-Yong Hahn  7
Affiliations

Moderate-Intensity Statins Plus Ezetimibe vs. High-Intensity Statins After Coronary Revascularization: A Cohort Study

Juwon Kim et al. Cardiovasc Drugs Ther. 2023 Feb.

Abstract

Purpose: Whether moderate-intensity statins plus ezetimibe could be an alternative to high-intensity statins in patients with atherosclerotic cardiovascular disease is unclear. We compared the risk of adverse cardiovascular events in patients receiving moderate-intensity statins plus ezetimibe vs. high-intensity statins after a coronary revascularization procedure using data from a large cohort study.

Method: Population-based cohort study using nationwide medical insurance data from Korea. Study participants (n = 20,070) underwent percutaneous coronary intervention or coronary artery bypass graft surgery between January 1, 2015, and December 31, 2016, and received moderate-intensity statins (atorvastatin 10-20 mg or rosuvastatin 5-10 mg) plus ezetimibe (n = 922) or high-intensity statins (atorvastatin 40-80 mg or rosuvastatin 20 mg; n = 19,148). The primary outcome was a composite of cardiovascular mortality, hospitalization for myocardial infarction (MI), hospitalization for stroke, or revascularization.

Results: At 12 months, the incidence rates of the primary outcome were 138.0 vs. 154.0 per 1000 person-years in the moderate-intensity stains plus ezetimibe and the high-intensity statins group, respectively. The fully adjusted hazard ratio [HR] for the primary outcome was 1.11 (95% confidence interval [CI] 0.86-1.42; p = 0.43). The multivariable-adjusted HR for a composite of cardiovascular mortality, hospitalization for MI, or hospitalization for stroke was 1.05 (95% CI 0.74-1.47; p = 0.80). During follow-up, the proportion of patients maintaining their initial lipid-lowering therapy was significantly higher in the moderate-intensity statins plus ezetimibe group than in the high-intensity statins group.

Conclusions: Patients undergoing a coronary revascularization procedure who received moderate-intensity statins plus ezetimibe showed similar rates of major adverse cardiovascular events as patients who received high-intensity statins.

Keywords: Coronary artery bypass graft surgery; Ezetimibe; Percutaneous coronary intervention; Secondary prevention; Statin.

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