Ezetimibe Plus Simvastatin Improves Clinical Outcomes

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Reduction in total primary end point events, driven by reductions in myocardial infarction, stroke.
Reduction in total primary end point events, driven by reductions in myocardial infarction, stroke.

(HealthDay News) -- Lipid-lowering therapy with ezetimibe plus simvastatin is associated with improved clinical outcomes, with a reduction in total primary end point (PEP) events, according to a study published in the Journal of the American College of Cardiology.

Noting that ezetimibe/simvastatin therapy in the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) significantly reduced the first PEPs in patients after acute coronary syndromes, Sabina A. Murphy, MPH, from Brigham and Women's Hospital in Boston, and colleagues examined whether total PEP events would also be reduced. They examined all PEP events during a median of 6 years of follow-up in 18,144 patients randomized to ezetimibe/simvastatin or placebo/simvastatin.

The researcher found that there were 9,545 total PEP events (56% first events; 44% subsequent events). Compared with placebo/simvastatin, there was a reduction in total PEP events with ezetimibe/simvastatin (incidence-rate ratio [RR], 0.91; P = 0.007), and reductions in the 3 pre-specified secondary composite end points and the exploratory composite end point of cardiovascular (CV) death, myocardial infarction (MI), or stroke (RR, 0.88; P = 0.002). Decreases in total nonfatal MI and total nonfatal stroke drove the reduction in total events (RRs, 0.87 [P = 0.004] and 0.77 [P = 0.005], respectively).

"These data support continuation of intensive combination lipid-lowering therapy after an initial CV event," the authors write.

Several authors disclosed financial ties to biopharmaceutical companies, including Merck, which manufactures ezetimibe/simvastatin and funded the IMPROVE-IT study.


  1. Murphy SA, Cannon CP, Blazing MA, et al. Reduction in Total Cardiovascular Events With Ezetimibe/Simvastatin Post-Acute Coronary Syndrome. J Am Coll Cardiol. 2016;67(4):353-361. doi:10.1016/j.jacc.2015.10.077.
  2. Scott Wright R and Murphy J. PROVE-IT to IMPROVE-IT: Why LDL-C Goals Still Matter in Post-ACS Patients. J Am Coll Cardiol. 2016;67(4):362-364. doi:10.1016/j.jacc.2015.11.016.

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