Intensified lipid lowering using ezetimibe after publication of the IMPROVE-IT trial: A contemporary analysis from the SPUM-ACS cohort.

Abstract

BACKGROUND:

The relevance of the IMPROVE-IT trial on real-life practice has not been explored in patients with ACS.

METHODS:

A prospective Swiss cohort of 6266 patients hospitalized for ACS between 2009 and 2017 with a one-year follow-up. The primary endpoints were the ezetimibe use overall or in combination with high-intensity statin at discharge and at one year after ACS. Secondary endpoint was LDL-C target achievement at one year in a subsample of 2984 patients. Relative Ratios (RR) were used to assess changes in primary endpoints before and after the publication of IMPROVE-IT, adjusting for age, sex, diabetes, prior myocardial infarction, LDL-C and attendance to cardiac rehabilitation.

RESULTS:

The period following the publication of the IMPROVE-IT trial was associated with a steady increase in the use of ezetimibe at discharge (from 1.8% to 3.8%, P < 0.001, adjusted RR 2.85, 95% CI 1.90-4.25) and at one year (from 5.0% to 13.8%, P < 0.001, adjusted RR 3.00, 95% CI 2.40-3.75). The combination of high-intensity statin and ezetimibe rose from 0.9% to 2.1% at discharge (P < 0.001, adjusted RR 3.35, 95% CI 1.90-5.89) and from 2.1% to 7.8% at one year (P < 0.001, adjusted RR 3.98, 95% CI 2.90-5.47). The period following the publication of the IMPROVE-IT trial was associated with an improvement of LDL-C target <1.8 mmol/L (adjusted RR 1.37, 95% CI 1.12-1.68).

CONCLUSIONS:

After the publication of the IMPROVE-IT trial, the use of ezetimibe was increased by three-fold in a large contemporary cohort of ACS patients, concomitant with an improved LDL-C target achievement.

• Authors: Baris Gencer, David Carballo, David Nanchen, Konstantinos C Koskinas, Roland Klingenberg, Lorenz Räber, Reto Auer, Sebastian Carballo, Dik Heg, Stephan Windecker, Thomas Felix Lüscher, Christian M Matter, Nicolas Rodondi, François Mach
• Journal: International journal of cardiology (Int J Cardiol) Vol. 303 Pg. 8-13 (03 15 2020) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 31859113 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)
• Copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Chemical References

• Anticholesteremic Agents
• Biomarkers
• Cholesterol, LDL
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Simvastatin
• Ezetimibe

Topics

• Acute Coronary Syndrome (blood, diagnosis, prevention & control)
• Anticholesteremic Agents (therapeutic use)
• Biomarkers (blood)
• Cholesterol, LDL (blood)
• Drug Therapy, Combination
• Ezetimibe (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Male
• Middle Aged
• Prospective Studies
• Simvastatin (therapeutic use)