Safety and efficacy of moderate-intensity statin plus ezetimibe versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease: A meta-analysis

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide and poses a significant healthcare related challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear.

Methods: A thorough literature study was conducted across PubMed, Embase, and the Cochrane databases, focusing on studies that compared the effects of MIS+EZT with HIS monotherapy in ASCVD patients.

Results: In the 13 included studies, involving 8,592 patients, 4,525 (52.67%) of which received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 4 to 156 weeks, with participant ages varying from 55.2 to 71 years old. Analysis revealed that MIS+EZT was associated with a significantly greater percentage of patients who achieved the goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL. (odds ratio [OR] 1.76; 95% CI [1.26; 2.45]; p = 0.001; I² = 73%); LDL-C reduction (mean difference [MD] -5.05 mg/dL; 95% CI [-9.02;-1.07]; p < 0.013; I² = 56%); total cholesterol reduction (MD -7.91 mg/ dL; 95% CI [-14.90; -0.91]; p < 0.027; I² = 60%) and triglyceride reduction (MD -8.20 mg/ dL; 95% CI [-13.05; -3.35]; p < 0.001; I² = 2%). There was no statistical difference between groups in drug adverse reaction (risk ratio [RR] 1.19; 95% CI [0.79; 1.78]; p = 0.404; I² = 0%) and drug intolerance (RR 0.78; 95% CI [0.32; 1.92]; p = 0.584; I² = 35%).

Conclusions: This meta-analysis highlights the effectiveness of MIS+EZT in significantly improving lipid profile components for ASCVD patients, as can been seen through the greater percentage of patients achieving the LDL-C < 70 mg/dL target and lower LDL-C, total cholesterol and triglyceride levels. Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.

Keywords: ASCVD; Ezetimibe; High-intensity statins; Moderate-intensity statins.