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. 2024 May 13:15:1343582.
doi: 10.3389/fphar.2024.1343582. eCollection 2024.

Effect of ezetimibe-statin combination therapy vs. statin monotherapy on coronary atheroma phenotype and lumen stenosis in patients with coronary artery disease: a meta-analysis and trial sequential analysis

Yun-Jing Zhang  1 , Min Xu  2 , Ji-Qiang Duan  2 , De-Jin Wang  3 , Shi-Liang Han  2
Affiliations

Effect of ezetimibe-statin combination therapy vs. statin monotherapy on coronary atheroma phenotype and lumen stenosis in patients with coronary artery disease: a meta-analysis and trial sequential analysis

Yun-Jing Zhang et al. Front Pharmacol. .

Abstract

Background: Evidence indicates that the addition of ezetimibe to statin therapy reduces cardiovascular events. However, the impact of ezetimibe-statin combination therapy on coronary plaque regression, plaque stabilization, and diameter stenosis remains a matter of controversy.

Methods: We performed electronic searches in PubMed, Web of Knowledge, and the Cochrane Central Register of Controlled Trials to identify eligible trials assessing the effects of ezetimibe-statin combination therapy versus statin monotherapy reporting at least one outcome among total atheroma volume (TAV), minimum fibrous cap thickness (FCT), lumen volume (LV), and lumen area (LA) derived from intravascular imaging modalities of intravascular ultrasound (IVUS) and optical coherence tomography (OCT). We used the random-effects model and performed trial sequential analysis (TSA) during this meta-analysis.

Results: Eleven articles with a total of 926 individuals (460 in the dual-lipid-lowering therapy group and 466 in the statin monotherapy group) were included in the final meta-analysis. Compared to statin monotherapy, ezetimibe-statin combination therapy was associated with significantly decreased TAV [WMD = -3.17, 95% CI (-5.42 to -0.92), and p = 0.006], with no effect on the LV of the coronary artery [WMD = -0.52, 95% CI (-2.24 to 1.21), and p = 0.56], the LA of the coronary artery [WMD = 0.16, 95% CI (-0.10-0.42), and p = 0.22], or minimum FCT thickness [WMD = 19.11, 95%CI (-12.76-50.97)].

Conclusion: In patients with coronary artery disease, ezetimibe-statin combination therapy resulted in a significant regression in TAV compared to statin monotherapy, whereas no overall improvements of minimum FCT or lumenal stenosis were observed.

Keywords: atheroma plaque; coronary plaques; ezetimibe; intravascular ultrasound; optical coherence tomography; statin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Study selection flow diagram.
FIGURE 2
FIGURE 2
Risk of bias assessment of included studies.
FIGURE 3
FIGURE 3
Forest plot of comparison showing change from baseline in total atheroma volume (A) and lumen volume (B) assessed by IVUS.
FIGURE 4
FIGURE 4
Forest plot of comparison showing the change in minimum fibrous cap thickness (A) and lumen area (B) assessed by OCT.
FIGURE 5
FIGURE 5
Trial sequential analysis for total atheroma volume (A) and minimum fibrous cap thickness (B).
FIGURE 6
FIGURE 6
Funnel plot evaluating publication bias. (A) Funnel plots of studies reporting total atheroma volume as a measure of treatment effect, and (B) Funnel plots of studies reporting minimum fibrous cap thickness as a measure of treatment effect.
See this image and copyright information in PMC

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