Prevention & lipidsCohort study
Combination of low- or moderate-intensity statin and ezetimibe vs. high-intensity statin monotherapy on primary prevention of cardiovascular disease and all-cause death: a propensity-matched nationwide cohort study
- Retrospective cohort study
- propensity-score matched
- nationwide
Authors' conclusion
Among people without pre-existing CVD, moderate-intensity statin with ezetimibe combination was superior to high-intensity statin monotherapy in preventing composite outcomes as well as each of MI and stroke. In contrast, low-intensity statin with ezetimibe combination reduced the risk of composite but not individual outcomes.
Study context
- Population
- People without pre-existing Cardiovascular Disease (CVD), Korean National Health Insurance Service datasetstwo 1:1 matched cohorts
- Exposure
- Low- or moderate-intensity statin + ezetimibe vs high-intensity statin monotherapy
- Outcome
- Composite of:
- MI
- Stroke
- All-cause death
Main finding
As reported in the abstract
Each group vs high-intensity statin monotherapyHazard ratio (95% CI)P value
Moderate-intensity statin + ezetimibe
0.84(0.77–0.92)
P < 0.001Low-intensity statin + ezetimibe
0.80(0.66–0.97)
P = 0.024Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| Individual outcomes (MI, stroke, all-cause death), moderate-intensity statin + ezetimibe — Moderate-intensity statin + ezetimibe vs High-intensity statin monotherapy · MI | 0.81 (0.71–0.94) | P = 0.005 | |
| Individual outcomes (MI, stroke, all-cause death), moderate-intensity statin + ezetimibe — Moderate-intensity statin + ezetimibe vs High-intensity statin monotherapy · stroke | 0.78 (0.65–0.93) | P = 0.005 | |
| 0.512Hazard ratio (log scale) |
Individual outcomes (myocardial infarction (MI), stroke, all-cause death), moderate-intensity statin + ezetimibe
- All-cause death not significantly reduced
Individual outcomes, low-intensity statin + ezetimibe
- Risk of individual outcomes did not differ vs high-intensity statin monotherapy
Subgroups
- Consistent effect of statin + ezetimibe across various subgroups
Original publication
Combination of low- or moderate-intensity statin and ezetimibe vs. high-intensity statin monotherapy on primary prevention of cardiovascular disease and all-cause death: a propensity-matched nationwide cohort study. Eur J Prev Cardiol. Published 26 February 2024. doi:10.1093/eurjpc/zwae081
Summarised from the published abstract; every number is checked against it