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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Acknowledgements
The authors would like to acknowledge Research Council of Pakistan (RCOP) for their support along all aspects of conducting this study.
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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, and Mohammad Hamza declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript.
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Ishaque Hameed: Resources, writing—review and editing, project administration. Syeda Ayesha Shah: Conceptualization, investigation, writing—original draft. Ashnah Aijaz: Formal analysis, writing—original draft. Hasan Mushahid: Investigation, writing—original draft, writing—review and editing. Syed Husain Farhan: Formal analysis, writing—original draft. Muhammad Dada: Methodology, writing—reviewing and editing. Adam Khan: Methodology, writing—original draft. Reeha Amjad: Formal analysis, writing—original draft, writing—review and editing. Fawad Alvi: Writing—original draft, writing—review and editing. Mustafa Murtaza: Methodology, writing—original draft. Zaid Zuberi: Methodology, writing—original draft. Mohammad Hamza: Writing—review and editing, project administration.
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Hameed, I., Shah, S.A., Aijaz, A. et al. 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. Am J Cardiovasc Drugs (2024). https://doi.org/10.1007/s40256-024-00642-8
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DOI: https://doi.org/10.1007/s40256-024-00642-8