Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS American Journal of Cardiovascular Drugs Pub Date : 2024-04-05 DOI:10.1007/s40256-024-00642-8

Ishaque Hameed, Syeda Ayesha Shah, Ashnah Aijaz, Hasan Mushahid, Syed Husain Farhan, Muhammad Dada, Adam Bilal Khan, Reeha Amjad, Fawad Alvi, Mustafa Murtaza, Zaid Zuberi, Mohammad Hamza

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Abstract

Aim

Statin therapy is considered the gold standard for treating hypercholesterolemia. This updated meta-analysis aims to compare the efficacy and safety of a low/moderate-intensity statin in combination with ezetimibe compared with high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (ASCVD).

Methods

A systematic search of two databases (PubMed and Cochrane CENTRAL) was conducted from inception to January 2023 and a total of 21 randomized clinical trials (RCTs) were identified and included in the analysis. Data were pooled using Hedges’s g and a Mantel–Haenszel random-effects model to derive standard mean differences (SMDs) and 95% confidence intervals (Cis). The primary outcome studied was the effect of these treatments on lipid parameters and safety events.

Results

The results revealed that combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels (SMD= − 0.41; CI − 0.63 to − 0.19; P = 0.0002). There was no significant change in the levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), Apo A1, or Apo B. The safety of these treatments was assessed by the following markers alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine phosphokinase (CK), and a significant difference was only observed in CK (SMD: − 0.81; CI − 1.52 to − 0.10; P = 0.02).

Conclusion

This meta-analysis demonstrated that the use of low/moderate-intensity statin combination therapy significantly reduced LDL-C levels compared with high-intensity statin monotherapy, making it preferable for patients with related risks. However, further trials are encouraged to evaluate potential adverse effects associated with combined therapy.

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动脉粥样硬化性心血管疾病患者接受低/中等强度他汀加依折麦布联合疗法与高强度他汀单药疗法的安全性和有效性比较：最新大都市分析

目的他汀疗法被认为是治疗高胆固醇血症的金标准。本最新荟萃分析旨在比较动脉粥样硬化性心血管疾病（ASCVD）患者中，低/中等强度他汀联合依折麦布与高强度他汀单药治疗的疗效和安全性。方法对两个数据库（PubMed 和 Cochrane CENTRAL）进行了从开始到 2023 年 1 月的系统检索，共确定了 21 项随机临床试验 (RCT) 并纳入分析。采用Hedges's g和Mantel-Haenszel随机效应模型对数据进行汇总，得出标准平均差（SMD）和95%置信区间（Cis）。研究的主要结果是这些疗法对血脂参数和安全事件的影响。结果结果显示，联合疗法能更有效地降低低密度脂蛋白胆固醇（LDL-C）水平（SMD= - 0.41；CI - 0.63 至 - 0.19；P = 0.0002）。高密度脂蛋白胆固醇（HDL-C）、总胆固醇（TC）、甘油三酯（TG）、高敏 C 反应蛋白（hs-CRP）、载脂蛋白 A1 或载脂蛋白 B 的水平没有明显变化。这些治疗方法的安全性通过以下指标进行评估：丙氨酸氨基转移酶（ALT）、天门冬氨酸氨基转移酶（AST）和肌酸磷酸激酶（CK）。81；CI - 1.52 to - 0.10；P = 0.02）。结论这项荟萃分析表明，与高强度他汀类药物单药治疗相比，使用低/中强度他汀类药物联合治疗可显著降低低密度脂蛋白胆固醇水平，因此对于有相关风险的患者来说，低/中强度他汀类药物联合治疗更可取。然而，我们鼓励开展更多试验，以评估与联合疗法相关的潜在不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.