Background: It is unknown whether the conclusion of the IMPROVE-IT trial can be extrapolated into patients taking high intensity statin plus ezetimibe. Therefore, a meta-analysis was performed to evaluate the impact of ezetimibe combined with high intensity statin on low-density lipoprotein cholesterol (LDL-C) levels in patients with hypercholesterolemia.
Methods: A systematic literature search was performed using PubMed and EMBASE and restricted to randomized controlled trials (RCTs) in patients with hypercholesterolemia. The outcome of this analysis was mean difference in LDL-C reduction in patients treated with high intensity statin plus ezetimibe compared to corresponding high intensity statin.
Results: Of the 404 citations, six RCTs involving 714 patients were included. Compared to the high intensity statin group, overall the mean difference in LDL-C reduction with high intensity statin plus ezetimibe was -12.07% (95% CI: -2.16 to -21.97; p=0.02). The results were associated with substantial heterogeneity (I2=84%, p<0.00001). Notably, the mean difference in LDL-C reduction was decreased to -8.6% (95% CI: -4.22 to -12.98; p=0.0001) with non-significant heterogeneity (p=0.27, I2=22%) when the Robinson 2014 study was omitted.
Conclusion: Among patients with hypercholesterolemia, adding ezetimibe to high intensity statin led to a mild but significant additional reduction in LDL-C levels compared to high intensity statin monotherapy.
Available at: http://works.bepress.com/jiehyun-lee/12/