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Similar Major Cardiovascular Outcomes Between Pure Statin and Ezetimibe-statin in Comparable Intensity for Type 2 Diabetes with Extremely Atherosclerotic Risks

Overview

Overview

Journal Sci Rep

Specialty Science

Date 2021 Mar 24

PMID 33758291

Citations 1

Authors

Authors

Yu-Cheng Kao

Tien-Hsing Chen

Chi-Hung Liu

Jawl-Shan Hwang

Ching-Chung Hsiao

Yu-Sheng Lin

Chun-Tai Mao

Ming-Jui Hung

Yan-Rong Li

Affiliations

Affiliations

Soon will be listed here.

Abstract

Atorvastatin 40 mg (ATOR 40) and ezetimibe 10 mg/simvastatin 20 mg (EZ-SIM 20) have similar reductions of low-density lipoprotein cholesterol (LDL-C) but cardiovascular (CV) outcomes between these two therapies are unclear. Our real-world cohort study is to test the hypothesis of pleiotropic effects of purely higher dose statin on CV outcomes beyond similar reductions of LDL-C, especially for extremely CV risk patients. Between January 1, 2007 and December 31, 2013, a total of 3,372 patients with type 2 diabetes mellitus (T2DM) admitted due to acute coronary syndrome (ACS) or acute ischemic stroke (AIS) were selected as the study cohort from the Taiwan National Health Insurance Research Database. Clinical outcomes were evaluated by ATOR 40 group (n = 1686) matched with EZ-SIM 20 group (n = 1686). Primary composite outcome includes CV death, non-fatal myocardial infarction, and non-fatal stroke. Secondary composite outcome includes hospitalization for unstable angina (HUA), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). With a mean follow-up of 2.4 years, no significant difference of primary composite outcome was observed between ATOR 40 and EZ-SIM 20 groups (subdistribution hazard ratio [SHR], 1.09; 95% confidence interval [CI], 0.95-1.25). Nevertheless, ATOR 40 group had lower risks of HUA (SHR, 0.50; 95% CI, 0.35-0.72), PCI (SHR, 0.82; 95% CI, 0.69-0.97) and CABG (SHR, 0.62; 95% CI, 0.40-0.97) than EZ-SIM 20 group. For T2DM patients after ACS or AIS, ATOR 40 and EZ-SIM 20 had similar major CV outcomes, which still supported the main driver for CV risk reductions is LDL-C lowering.

Citing Articles

The clinical effectiveness and safety of low/moderate-intensity statins & ezetimibe combination therapy vs. high-intensity statin monotherapy: a systematic review and meta-analysis.

Sydhom P, Al-Quraishi B, El-Shawaf M, Osman M, Naji N, Awwad N BMC Cardiovasc Disord. 2024; 24(1):660.

PMID: 39567875 PMC: 11577940. DOI: 10.1186/s12872-024-04144-y.

References

1.

Stamler J, Wentworth D, Neaton J . Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA. 1986; 256(20):2823-8. View

2.

Liu P, Liu Y, Lin L, Chen J, Liao J . Evidence for statin pleiotropy in humans: differential effects of statins and ezetimibe on rho-associated coiled-coil containing protein kinase activity, endothelial function, and inflammation. Circulation. 2008; 119(1):131-8. PMC: 2745913. DOI: 10.1161/CIRCULATIONAHA.108.813311. View

3.

Lin C, Lai M, Syu C, Chang S, Tseng F . Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. J Formos Med Assoc. 2005; 104(3):157-63. View

4.

Cannon C, Blazing M, Giugliano R, McCagg A, White J, Theroux P . Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med. 2015; 372(25):2387-97. DOI: 10.1056/NEJMoa1410489. View

5.

Liu C, Chen T, Lin M, Hung M, Chung C, Cherng W . Ezetimibe-Simvastatin Therapy Reduce Recurrent Ischemic Stroke Risks in Type 2 Diabetic Patients. J Clin Endocrinol Metab. 2016; 101(8):2994-3001. DOI: 10.1210/jc.2016-1831. View

6.

Ouchi Y, Sasaki J, Arai H, Yokote K, Harada K, Katayama Y . Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older (EWTOPIA 75): A Randomized, Controlled Trial. Circulation. 2019; 140(12):992-1003. DOI: 10.1161/CIRCULATIONAHA.118.039415. View

7.

Ference B, Majeed F, Penumetcha R, Flack J, Brook R . Effect of naturally random allocation to lower low-density lipoprotein cholesterol on the risk of coronary heart disease mediated by polymorphisms in NPC1L1, HMGCR, or both: a 2 × 2 factorial Mendelian randomization study. J Am Coll Cardiol. 2015; 65(15):1552-61. PMC: 6101243. DOI: 10.1016/j.jacc.2015.02.020. View

8.

Cheng C, Kao Y, Lin S, Lee C, Lai M . Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan. Pharmacoepidemiol Drug Saf. 2011; 20(3):236-42. DOI: 10.1002/pds.2087. View

9.

Nawrocki J, Weiss S, Davidson M, Sprecher D, Schwartz S, Lupien P . Reduction of LDL cholesterol by 25% to 60% in patients with primary hypercholesterolemia by atorvastatin, a new HMG-CoA reductase inhibitor. Arterioscler Thromb Vasc Biol. 1995; 15(5):678-82. DOI: 10.1161/01.atv.15.5.678. View

10.

Jarcho J, Keaney Jr J . Proof That Lower Is Better--LDL Cholesterol and IMPROVE-IT. N Engl J Med. 2015; 372(25):2448-50. DOI: 10.1056/NEJMe1507041. View

11.

Liao J, Laufs U . Pleiotropic effects of statins. Annu Rev Pharmacol Toxicol. 2005; 45:89-118. PMC: 2694580. DOI: 10.1146/annurev.pharmtox.45.120403.095748. View

12.

Austin P, Fine J . Propensity-score matching with competing risks in survival analysis. Stat Med. 2018; 38(5):751-777. PMC: 6900780. DOI: 10.1002/sim.8008. View

13.

Chung C, Lin M, Chang C, Cheng H, Chang S, Wang P . Moderate to high intensity statin in dialysis patients after acute myocardial infarction: A national cohort study in Asia. Atherosclerosis. 2017; 267:158-166. DOI: 10.1016/j.atherosclerosis.2017.09.018. View

14.

Fichtlscherer S, Schmidt-Lucke C, Bojunga S, Rossig L, Heeschen C, Dimmeler S . Differential effects of short-term lipid lowering with ezetimibe and statins on endothelial function in patients with CAD: clinical evidence for 'pleiotropic' functions of statin therapy. Eur Heart J. 2006; 27(10):1182-90. DOI: 10.1093/eurheartj/ehi881. View

15.

Galin I, Smith D . Dose-comparison study of the combination of ezetimibe and simvastatin (Vytorin) versus atorvastatin in patients with hypercholesterolemia: the Vytorin Versus Atorvastatin (VYVA) Study. Am Heart J. 2006; 151(5):e1. DOI: 10.1016/j.ahj.2005.10.009. View

16.

Kawagoe Y, Hattori Y, Nakano A, Aoki C, Tanaka S, Ohta S . Comparative study between high-dose fluvastatin and low-dose fluvastatin and ezetimibe with regard to the effect on endothelial function in diabetic patients. Endocr J. 2011; 58(3):171-5. DOI: 10.1507/endocrj.k10e-289. View

17.

Cheng C, Chien H, Lee C, Lin S, Kao Yang Y . Validity of in-hospital mortality data among patients with acute myocardial infarction or stroke in National Health Insurance Research Database in Taiwan. Int J Cardiol. 2015; 201:96-101. DOI: 10.1016/j.ijcard.2015.07.075. View

18.

Li Y, Ueng K, Jeng J, Charng M, Lin T, Chien K . 2017 Taiwan lipid guidelines for high risk patients. J Formos Med Assoc. 2017; 116(4):217-248. DOI: 10.1016/j.jfma.2016.11.013. View

19.

Shou J, Zhou L, Zhu S, Zhang X . Diabetes is an Independent Risk Factor for Stroke Recurrence in Stroke Patients: A Meta-analysis. J Stroke Cerebrovasc Dis. 2015; 24(9):1961-8. DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.004. View

20.

Li Y, Tsai S, Lin Y, Chung C, Chen S, Sun J . Moderate- to high-intensity statins for secondary prevention in patients with type 2 diabetes mellitus on dialysis after acute myocardial infarction. Diabetol Metab Syndr. 2017; 9:71. PMC: 5605978. DOI: 10.1186/s13098-017-0272-7. View