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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
Roshini Claire Anthony, 11 Feb 2020

The consumption of processed meat or unprocessed red meat may be associated with a slightly elevated risk of incident cardiovascular disease (CVD)* and all-cause mortality, according to a US study.

29 Jan 2020
Several high-density lipoprotein (HDL) functionality parameters, which are linked to HDL roles on cholesterol metabolism, endothelial protection and antioxidant/anti-inflammatory defence, contribute to an increased risk of incident acute coronary syndromes and its manifestations in individuals at high risk of cardiovascular disease, a study reports.
Jairia Dela Cruz, 5 days ago
A wearable arrhythmia detection device, the AliveCor KardiaBand (KB), demonstrates moderate accuracy for diagnosing atrial fibrillation (AF) in comparison with a 12-lead electrocardiogram (ECG), as shown in a recent study. However, combining the automated device diagnosis with the electrophysiologists (EP) interpretation of unclassified readings improves overall accuracy.
Pearl Toh, 10 Feb 2020
Contrary to popular concern, use of statins was not associated with a greater decline in memory or cognition in the elderly over 6 years, according to data from the observational MAS*.