New results from a vast Mayo Clinic meta-analysis suggest that combining ezetimibe with statins to lower LDL-C could have significant mortality and MACE benefits over statin monotherapy.
- Statins are one of the most prescribed drugs in the U.S., with over 25% of all adults 40 and up taking them.
- However, not everyone with high cholesterol benefits from statins, leading many drug developers to focus on novel ways to lower LDL-C levels.
Digging through decades of data from PubMed, Embase, and ClinicalTrials.gov, researchers pooled all relevant articles published through June 2024 (108k patients) and found that a combination lipid-lowering therapy (LLT) of statins plus ezetimibe led to significantly better CV outcomes compared to statin monotherapy. Combination LLT patients showed…
- Greater baseline LDL-C reduction (mean difference, −12.96 mg/dL).
- Significantly reduced all-cause mortality (OR: 0.81).
- Lower MACE risk (OR: 0.82).
- And fewer strokes (OR: 0.83).
- Meanwhile, adverse events and discontinuation rates were similar for both combination LLT and monotherapy.
Where LLT fell short was its effect on cardiovascular mortality, which was lower (OR: 0.86), but not statistically significant compared to statin monotherapy.
Above all else, these results support the current guidelines that recommend adding ezetimibe to statin therapy when patient LDL-C targets aren’t met, yet a 2023 AHA study found only 4.4% of patients with high LDL-C were on ezetimibe.
The Takeaway
It might seem obvious that adding a cholesterol lowering drug to a statin regimen makes it better at LDL-C reduction, but this study is an important reminder to cardiologists to keep all pharmaceutical tools in mind, especially since ezetimibe has repeatedly shown to be effective yet is still seriously underused.
