Effectiveness of Ezetimibe in Reducing the Estimated Risk for Fatal Cardiovascular Events in Hypercholesterolaemic Patients with Inadequate Lipid Control While on Statin Monotherapy as Measured by the SCORE Model

John S Sampalis,Stella Boukas,Stéphane Bissonnette

doi:10.4061/2011/597163

Abstract

Objectives. The aim of this prospective cohort, multicentre study was to assess the effect of coadministrating ezetimibe 10 mg/day with an ongoing statin on the estimated risk for Cardiovascular (CVD) mortality in patients with persistently elevated LDL-C after statin monotherapy. Methods. The Systematic Coronary Risk Evaluation (SCORE) function was used to estimate the 10-year risk for cardiovascular mortality at baseline and 6 weeks. Primary outcome measures were absolute and percent changes in estimated Coronary Heart Disease (CHD) Mortality Risk, and general CVD Mortality Risk (Total CVD Mortality Risk). Results. 825 patients were included in the analysis. Mean (SD) age was 62 (10.5) years and 62.3% were males. The mean (SD) estimated Total CVD Mortality Risk decreased from 0.068 (0.059) at baseline to 0.053 (0.046) at 6 weeks (RR = 0.77; 95% CI:0.689–0.867), while the estimated CHD Mortality Risk decreased from 0.047 (0.040) at baseline to 0.034 (0.029) at 6 weeks (RR = 0.72; 95% CI:0.624–0.826). Conclusions. Co-administration of ezetimibe with a statin is effective in significantly reducing the estimated risk for cardiovascular mortality as measured by the SCORE model.

Highlights

Cardiovascular disease is the major cause of mortality in Canada, accounting for one-third of all deaths, with an incidence expected to increase within the decade [1]
The metabolic syndrome was defined according to the American Heart Association (AHA) criteria published at the time of the study [24], while hypertension was based on the diagnosis of the treating physician
Combination of ezetimibe with low-dose statin has been shown to be effective in improving the lipid profile, providing an additional 20% to 25% reduction in low density lipoprotein cholesterol (LDL-C) compared to statin monotherapy [9, 25], while potentially protecting from the risk of adverse events associated with high-dose statins through moderating the dose of co-administrated statin [20,21,22]

Summary

Introduction

Cardiovascular disease is the major cause of mortality in Canada, accounting for one-third of all deaths, with an incidence expected to increase within the decade [1]. Low-density lipoprotein cholesterol (LDL-C), is directly associated with an increased risk for cardiovascular disease (CVD) [2,3,4,5]. Initiation of lipid-lowering pharmacologic intervention for the management of hypercholesterolaemia is generally dependent on the individual patient’s estimated risk for cardiovascular events [3, 6, 7]. The aim of lipidlowering treatment is to effectively reduce the individual patient’s risk for CVD, decreasing related mortality, morbidity and burden of illness. A cardiovascular risk prediction model was developed by the SCORE The model predicts the individual’s 10-year risk for fatal cardiovascular events on the basis of age, gender, smoking status, systolic blood pressure (SBP), and total cholesterol (TC). The total SCORE risk is further subdivided into the risk for fatal CHD and other non-CHD cardiovascular death

Objectives

Methods

Results

Conclusion