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Observational Study
. 2023 Aug 1;82(5):401-410.
doi: 10.1016/j.jacc.2023.05.042.

Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention

Seung-Jun Lee  1 , Jae Hong Joo  2 , Sohee Park  3 , Choongki Kim  4 , Dong-Woo Choi  5 , Sung-Jin Hong  1 , Chul-Min Ahn  1 , Jung-Sun Kim  1 , Byeong-Keuk Kim  1 , Young-Guk Ko  1 , Donghoon Choi  1 , Yangsoo Jang  6 , Chung-Mo Nam  7 , Myeong-Ki Hong  8
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Free article
Observational Study

Combination Lipid-Lowering Therapy in Patients Undergoing Percutaneous Coronary Intervention

Seung-Jun Lee et al. J Am Coll Cardiol. .
Free article

Abstract

Background: The RACING (randomized comparison of efficacy and safety of lipid-lowering with statin monotherapy versus statin/ezetimibe combination for high-risk cardiovascular diseases) trial examined the effects of combination therapy with moderate-intensity statin and ezetimibe in patients with atherosclerotic cardiovascular disease compared with high-intensity statin monotherapy.

Objectives: This observational study was conducted to evaluate the impact of 2 treatment strategies used in the RACING trial in clinical practice.

Methods: After stabilized inverse probability of treatment weighting, a total of 72,050 patients who were prescribed rosuvastatin after drug-eluting stent implantation were identified from a nationwide cohort database: 10,794 patients with rosuvastatin 10 mg plus ezetimibe 10 mg (combination lipid-lowering therapy) and 61,256 patients with rosuvastatin 20 mg monotherapy. The primary endpoint was the 3-year composite event of cardiovascular death, myocardial infarction, coronary artery revascularization, hospitalization for heart failure treatment, or nonfatal stroke in accordance with the RACING trial.

Results: Combination lipid-lowering therapy was associated with a lower occurrence of the primary endpoint (11.6% vs 15.2% for those with high-intensity statin monotherapy; HR: 0.75; 95% CI: 0.70-0.79; P < 0.001). Compared with high-intensity statin monotherapy, combination lipid-lowering therapy was associated with fewer discontinuations of statin (6.5% vs 7.6%; HR: 0.85; 95% CI: 0.78-0.94: P < 0.001) and a lower occurrence of new-onset diabetes requiring medication (7.7% vs 9.6%; HR: 0.80; 95% CI: 0.72-0.88; P < 0.001).

Conclusions: In clinical practice, combination lipid-lowering therapy with ezetimibe and moderate-intensity statin was associated with favorable clinical outcomes and drug compliance in patients treated with drug-eluting stent implantation. (CONNECT DES Registry; NCT04715594).

Keywords: coronary artery disease; dyslipidemia; statin.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported by the Cardiovascular Research Center, Seoul, Korea. The funder had no role in the design and conduct of the study; data collection, management, statistical analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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