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Ezetimibe boosts statin effect in ACS patients with dyslipidaemia, low EPA/AA ratio

Tristan Manalac
11 Sep 2019

The addition of ezetimibe improves statin treatment in acute coronary syndrome (ACS) patients with dyslipidaemia and low eicosapentaenoic acid-to-arachidonic acid (EPA/AA) ratio, resulting in a lowered risk of cardiovascular events compared to monotherapy, according to a study presented at the recently concluded 2019 Congress of the European Society of Cardiology (ESC 2019) held in Paris, France.

Researchers performed a sub-analysis of the HIJ-PROPER* study, where 1,734 ACS patients with dyslipidaemia were assigned to receive pitavastatin either alone or with ezetimibe. In the present study, participants were grouped into high (n=603; mean age, 68.7±9.8 years) and low (n=584; mean age, 62.6±12.6 years) EPA/AA groups based on a cutoff value of 0.34 µg/mL.

In the low EPA/AA group, the primary endpointa composite of all-cause death, nonfatal stroke and myocardial infarction, ischaemia-driven revascularization, and unstable angina pectorisoccurred in 36.6 percent and 27.2 percent of patients who received pitavastatin alone or with ezetimibe, respectively. [ESC 2019, abstract P824]

The resulting reduction in risk was statistically significant (hazard ratio [HR], 0.69, 95 percent CI, 0.52–0.93; p=0.02). This was driven primarily by the effect of add-on ezetimibe on ischaemia-driven revascularization, which occurred significantly less frequently in those who received the combination intervention (20.3 percent vs 30.4 percent; HR, 0.63, 0.45–0.87; p<0.01).

The other components of the primary composite outcome did not differ between treatment groups: all-cause death (HR, 0.65, 0.32–1.30; p=0.22), nonfatal myocardial infarction (HR, 0.43, 0.06–2.24; p=0.32) and stroke (HR, 2.1, 0.58–9.6; p=0.27), and unstable angina pectoris (HR, 1.35, 0.61–3.11; p=0.45).

Similarly, ezetimibe did not seem to yield any additional benefit for participants with high baseline EPA/AA, such that the primary composite outcome occurred with similar frequency between treatment groups (36.6 percent vs 33.0 percent; HR, 0.92, 0.70–1.20; p=0.52).

Disaggregation into the individual components did not change the initial finding.

Researchers then performed multivariable analysis in the low-EPA/AA group to search for independent predictors of the primary outcome. The use of ezetimibe was identified as a significant protective factor (HR, 0.70, 0.52–0.94; p=0.02), as were high-density lipoprotein cholesterol (HR, 0.88, 0.78–1.01; p=0.05) and docosahexaenoic acid (HR, 0.95, 0.91–0.99; p=0.04).

Glomerular filtration rate (HR, 0.92, 0.85–1.01; p=0.09) and non-ST elevation myocardial infarction (HR, 0.59, 0.29–1.06; p=0.08) also emerged as putative protective factors, though only of borderline significance.

“Among ACS patients who had dyslipidaemia with baseline EPA/AA ratio <0.34, combination therapy with ezetimibe and statin decreased the risk of cardiovascular events compared with statin monotherapy,” researchers concluded.

*Heart Institute of Japan-Proper level of lipid lowering with Pitavastatin and Ezetimibe in acute coronary syndrome

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Most Read Articles
07 Sep 2019
Eating mushrooms has no correlation with biomarkers and risks of cardiovascular disease (CVD) and type 2 diabetes (T2D) in adults, a US study has shown.
03 Sep 2019
Sleep apnoea is highly prevalent but largely undetected in the general population of middle-aged adults, with a symptom-based strategy proving to be useless for specific diagnosis, according to a recent study. Moreover, mild sleep apnoea represents a higher-risk phenotype with manifestly increased metabolic, inflammatory and cardiovascular risk factor burden, with potential public health implications.
Rachel Soon, 4 days ago

Adding simvastatin as an adjuvant to standard triple therapy in Helicobacter pylori treatment may help compensate for increasing antimicrobial resistance, according to a new study.

Christina Lau, 03 Sep 2019
The sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin significantly reduces the risk of death and hospitalization in patients with heart failure (HF) with reduced ejection fraction (rEF) regardless of whether they have type 2 diabetes mellitus (T2DM), the DAPA-HF trial has shown.