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Comparative Study
. 2024 Nov 5;23(1):396.
doi: 10.1186/s12933-024-02498-3.

Efficacy and diabetes risk of moderate-intensity statin plus ezetimibe versus high-intensity statin after percutaneous coronary intervention

Eun Ho Choo  1   2 , Donggyu Moon  2   3 , Ik Jun Choi #  4   5 , Sungmin Lim #  6   7 , Jungkuk Lee  8 , Dongwoo Kang  8 , Byung-Hee Hwang  1 , Chan Joon Kim  9 , Jong-Min Lee  9 , Ki-Dong Yoo  3 , Doo Soo Jeon  2 , Kiyuk Chang  1   2
Affiliations
Comparative Study

Efficacy and diabetes risk of moderate-intensity statin plus ezetimibe versus high-intensity statin after percutaneous coronary intervention

Eun Ho Choo et al. Cardiovasc Diabetol. .

Abstract

Backgrounds: High-intensity statin is recommended for patients undergoing percutaneous coronary intervention (PCI), and ezetimibe is recommended to be added in patients not achieving low-density lipoprotein cholesterol (LDL-C) targets. Moderate-intensity statin plus ezetimibe can reduce LDL-C levels similar to high-intensity statin. The aim of this study is to examine the long-term efficacy and safety of moderate-intensity statin plus ezetimibe as the first-line strategy compared to high-intensity statin in patients undergoing PCI.

Method: Data was obtained from the Health Insurance Review and Assessment Service database of South Korea. Patients who underwent PCI from 2012 to 2017 were included. The primary efficacy endpoint was major adverse cardiac cerebrovascular events (MACCEs), a composite of all-cause death, revascularization, or ischemic stroke. The safety endpoint was new-onset diabetes mellitus (DM).

Results: A total of 45,501 patients received high-intensity statin (n = 38,340) or moderate-intensity statin plus ezetimibe (n = 7,161). Among propensity-score-matched 7,161 pairs, MACCEs occurred in 1,460 patients with high-intensity statin and 1,406 patients with moderate-intensity statin plus ezetimibe (33.8% vs. 31.9%, hazard ratio 0.96, 95% confidence interval 0.89-1.03, P = 0.27) at a median follow-up of 2.7 years. DM was newly diagnosed in 398 patients with high-intensity statin and 342 patients with moderate-intensity statin plus ezetimibe (12.5% vs. 10.7%; hazard ratio 0.84, 95% confidence interval 0.73-0.97, P = 0.02).

Conclusion: In patients undergoing PCI, moderate-intensity statin plus ezetimibe demonstrated a similar risk of MACCEs but a lower risk of new-onset DM than high-intensity statin. Early combination treatment of moderate-intensity statin and ezetimibe may be a useful and safe lipid-lowering strategy after PCI.

Keywords: Coronary artery disease; Dyslipidemia; Ezetimibe; Percutaneous coronary intervention; Statin.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow chart
Fig. 2
Fig. 2
Six-year Kaplan-Meier estimated percentage for (A) major adverse cardiac cerebrovascular events and (B) new-onset diabetes mellitus in the propensity score-matched population. Abbreviation: HIS, high-intensity statin; MIS + Eze, moderate-intensity statin plus ezetimibe
Fig. 3
Fig. 3
Subgroup analysis for risk of major adverse cardiac cerebrovascular events in the propensity score-matched population. Abbreviation: AMI, acute myocardial infarction; HIS, high-intensity statin; MIS + Eze, moderate-intensity statin plus ezetimibe; PCI, percutaneous coronary intervention
Fig. 4
Fig. 4
Subgroup analysis for a risk of new-onset diabetes mellitus in the propensity score-matched population. Abbreviation: AMI, acute myocardial infarction; HIS, high-intensity statin; MIS + Eze, moderate-intensity statin plus ezetimibe; PCI, percutaneous coronary intervention
See this image and copyright information in PMC

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