New LDL-Lowering Drug May Benefit ACS Patients

Combining statin therapy with the cholesterol lowering, non-statin drug ezetimibe reduces the risk of heart attack and stroke in patients with acute coronary syndrome (ACS), according to a new study.

In order to evaluate the possible benefits of the drug combination in high risk ACS patients, researchers enrolled 18,144 participants (age 50 and older) from 1158 centers across 39 countries. The study participants were all previously diagnosed with ACS and had LDL cholesterol levels of 125 and lower without statins or 100 and lower if on statins.
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Patients were enrolled within 10 days of hospitalization for heart attack or unstable angina. About 5000 had experienced ST-segment elevation myocardial infarction (STEMI), and about 13,000 had experienced non-STEMI heart attack or unstable angina. All participants had at least 1 other risk factor for future cardiovascular events.

Patients were randomly assigned to either: simvastatin—to blocks cholesterol production in the liver—and placebo, or simvastatin in combination with ezetimibe—to inhibit the absorption of cholesterol in the intestine.

Compared with the placebo group, individuals taking the combination of simvastatin and ezetimibe had a 6.4% lower risk of all cardiovascular events, 14% lower risk of heart attacks, 14% lower risk of stroke, and 21% lower risk of ischemic stroke.

On average, the combination of simvastatin and ezetimibe lowered LDL cholesterol to 54 mg/dL versus 69 mg/dL with placebo.

“We took those patients from a clinically appropriate target LDL-C to even lower. We now have solid evidence that lower is good, and even lower can be even better,” researchers concluded.

Researchers further noted that combination therapy with ezetimibe did not raise the patients’ risk of adverse side effects, unlike patients who take higher-than-average dose statins.

—Michael Potts

Reference:

1. American Heart Association. Cholesterol-lowering drug with different action adds to statin’s reduction of cardiovascular risk [press release]. November 17, 2014. htpp://newsroom.heart.org/news/cholesterol-lowering-drug-with-different-action-adds-to-statins-reduction-of-cardiovascular-risk. Accessed November 19, 2014.