Purpose

Whether moderate-intensity statins plus ezetimibe could be an alternative to high-intensity statins in patients with atherosclerotic cardiovascular disease is unclear. We compared the risk of adverse cardiovascular events in patients receiving moderate-intensity statins plus ezetimibe vs. high-intensity statins after a coronary revascularization procedure using data from a large cohort study.

Method

Population-based cohort study using nationwide medical insurance data from Korea. Study participants (n = 20,070) underwent percutaneous coronary intervention or coronary artery bypass graft surgery between January 1, 2015, and December 31, 2016, and received moderate-intensity statins (atorvastatin 10–20 mg or rosuvastatin 5–10 mg) plus ezetimibe (n = 922) or high-intensity statins (atorvastatin 40–80 mg or rosuvastatin 20 mg; n = 19,148). The primary outcome was a composite of cardiovascular mortality, hospitalization for myocardial infarction (MI), hospitalization for stroke, or revascularization.

Results

At 12 months, the incidence rates of the primary outcome were 138.0 vs. 154.0 per 1000 person-years in the moderate-intensity stains plus ezetimibe and the high-intensity statins group, respectively. The fully adjusted hazard ratio [HR] for the primary outcome was 1.11 (95% confidence interval [CI] 0.86–1.42; p = 0.43). The multivariable-adjusted HR for a composite of cardiovascular mortality, hospitalization for MI, or hospitalization for stroke was 1.05 (95% CI 0.74–1.47; p = 0.80). During follow-up, the proportion of patients maintaining their initial lipid-lowering therapy was significantly higher in the moderate-intensity statins plus ezetimibe group than in the high-intensity statins group.

Conclusions

Patients undergoing a coronary revascularization procedure who received moderate-intensity statins plus ezetimibe showed similar rates of major adverse cardiovascular events as patients who received high-intensity statins.

中文翻译：

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冠状动脉血运重建后中等强度他汀类药物加依泽替米贝与高强度他汀类药物：一项队列研究

目的

中等强度他汀类药物联合依折麦布是否可以替代高强度他汀类药物治疗动脉粥样硬化性心血管疾病患者尚不清楚。我们使用一项大型队列研究的数据比较了冠状动脉血运重建术后接受中等强度他汀类药物加依折麦布与高强度他汀类药物的患者发生不良心血管事件的风险。

方法

使用韩国全国医疗保险数据的基于人群的队列研究。研究参与者 ( n  = 20,070) 在 2015 年 1 月 1 日至 2016 年 12 月 31 日期间接受了经皮冠状动脉介入治疗或冠状动脉旁路移植手术，并接受中等强度他汀类药物（阿托伐他汀 10-20 mg 或瑞舒伐他汀 5-10 mg）加依折麦布( n  = 922) 或高强度他汀类药物（阿托伐他汀 40–80 mg 或瑞舒伐他汀 20 mg；n  = 19,148）。主要结局是心血管死亡率、心肌梗死 (MI) 住院、中风住院或血运重建的综合结果。

结果

在 12 个月时，中等强度染色加依折麦布组和高强度他汀类药物组的主要结局发生率分别为每 1000 人年138.0 和 154.0 。主要结局的完全调整风险比 [HR] 为 1.11（95% 置信区间 [CI] 0.86–1.42；p = 0.43）。心血管死亡率、因 MI 住院或因卒中住院的复合的多变量调整 HR 为 1.05（95% CI 0.74–1.47；p = 0.80）。随访期间，中等强度他汀联合依折麦布组维持初始降脂治疗的患者比例显着高于高强度他汀组。

结论

接受中等强度他汀类药物加依折麦布的冠状动脉血运重建术患者与接受高强度他汀类药物的患者显示出相似的主要不良心血管事件发生率。