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
Randomized Controlled Trial
. 2023 Apr 11;81(14):1339-1349.
doi: 10.1016/j.jacc.2023.02.007.

Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients With Atherosclerosis

Sang-Hyup Lee  1 , Yong-Joon Lee  1 , Jung Ho Heo  2 , Seung-Ho Hur  3 , Hyun Hee Choi  4 , Kyung-Jin Kim  5 , Ju Han Kim  6 , Keun-Ho Park  7 , Jung Hee Lee  8 , Yu Jeong Choi  9 , Seung-Jun Lee  1 , Sung-Jin Hong  1 , Chul-Min Ahn  1 , Byeong-Keuk Kim  1 , Young-Guk Ko  1 , Donghoon Choi  1 , Myeong-Ki Hong  1 , Yangsoo Jang  10 , Jung-Sun Kim  11
Affiliations
Free article
Randomized Controlled Trial

Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients With Atherosclerosis

Sang-Hyup Lee et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The routine use of high-intensity statins should be considered carefully in elderly patients because of their higher risk of intolerance or adverse events.

Objectives: We evaluated the impact of moderate-intensity statin with ezetimibe combination therapy compared with high-intensity statin monotherapy in elderly patients with atherosclerotic cardiovascular disease (ASCVD).

Methods: In this post hoc analysis of the RACING (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases) trial, patients were stratified by age (≥75 years and <75 years). The primary endpoint was a 3-year composite of cardiovascular death, major cardiovascular events, or nonfatal stroke.

Results: Among the 3,780 enrolled patients, 574 (15.2%) were aged ≥75 years. The rates of the primary endpoint were not different between the moderate-intensity statin with ezetimibe combination therapy group and the high-intensity statin monotherapy group among patients aged ≥75 years (10.6% vs 12.3%; HR: 0.87; 95% CI: 0.54-1.42; P = 0.581) and those <75 years (8.8% vs 9.4%; HR: 0.94; 95% CI: 0.74-1.18; P = 0.570) (P for interaction = 0.797). Moderate-intensity statin with ezetimibe combination therapy was associated with lower rates of intolerance-related drug discontinuation or dose reduction among patients aged ≥75 years (2.3% vs 7.2%; P = 0.010) and those <75 years (5.2% vs 8.4%; P < 0.001) (P for interaction = 0.159).

Conclusions: Moderate-intensity statin with ezetimibe combination therapy showed similar cardiovascular benefits to those of high-intensity statin monotherapy with lower intolerance-related drug discontinuation or dose reduction in elderly patients with ASCVD having a higher risk of intolerance, nonadherence, and discontinuation with high-intensity statin therapy. (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases [RACING Trial]; NCT03044665).

Keywords: atherosclerotic cardiovascular disease; elderly; ezetimibe; statin.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures Hanmi Pharmaceutical, Seoul, Korea, has provided funding for this paper. Dr Byeong-Keuk Kim has received speaker fees from Medtronic and Abbott Vascular. Dr Myeong-Ki Hong has received speaker fees from Medtronic, Abbott Vascular, and Pfizer. Dr Yangsoo Jang has received institutional research grants from Biotronik and Hanmi. Dr Jung-Sun Kim has received proctoring fees from Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

Publication types

Associated data