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Meta-Analysis
. 2025 Jan 1;36(1):9-17.
doi: 10.1097/MCA.0000000000001407. Epub 2024 Sep 6.

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

Gustavo de Oliveira Almeida  1 , Caroline Balieiro  2 , Edmundo Damiani Bertoli  3 , Maria Eduarda Liporaci Moreira  1 , Ana Laura Soares Silva  1 , Bárbara Silvestre Minucci  1 , Isabella Zapparoli  1 , Marcela Silva Maluf  1 , Henrique Champs Porfírio Carvalho  1 , Rafael Dos Santos Borges  4 , Eric Pasqualotto  5 , Thiago Nienkötter  3 , Vinícius Alves  6 , Camila Mota Guida  7
Affiliations
Meta-Analysis

Cardiovascular benefits of statin plus ezetimibe combination therapy versus statin monotherapy in acute coronary syndrome: a meta-analysis of randomized controlled trials

Gustavo de Oliveira Almeida et al. Coron Artery Dis. .

Abstract

Background: The efficacy of adding ezetimibe to statin therapy for event reduction in patients with acute coronary syndromes (ACS) remains a topic of ongoing debate.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ezetimibe plus statin versus statin monotherapy in patients with ACS. We searched PubMed, Embase, and Cochrane for eligible trials. The random-effects model was used to calculate the risk ratios with 95% confidence intervals (CIs). Statistical analyses were performed using RStudio version 4.2.3 (RStudio, PBC).

Results: Six RCTs comprising 20 574 patients with ACS were included, of whom 10 259 (49.9%) were prescribed ezetimibe plus statin. The patient population had an average age of 63.8 years, and 75.1% were male. Compared with statin monotherapy, ezetimibe plus statin significantly reduced major adverse cardiovascular events (MACE) (risk ratio 0.93; 95% CI 0.90-0.97; P < 0.01) and nonfatal myocardial infarction (risk ratio 0.88; 95% CI 0.81-0.95; P < 0.01). There was no significant difference between groups for revascularization (risk ratio 0.94; 95% CI 0.90-1.00; P = 0.03), all-cause mortality (risk ratio 0.87; 95% CI 0.63-1.21; P = 0.42), or unstable angina (risk ratio 1.05; 95% CI 0.86-1.27; P = 0.64).

Conclusion: In this meta-analysis of patients with ACS, the combination of ezetimibe plus statin was associated with a reduction in MACE and nonfatal myocardial infarction, compared with statin monotherapy.

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