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Combination Moderate-Intensity Statinand Ezetimibe Therapy for Elderly Patients With Atherosclerosis

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Author(s)
Sang-Hyup LeeYong-Joon LeeJung Ho HeoSeung-Ho HurHyun Hee ChoiKyung-Jin KimJu Han KimKeun-Ho ParkJung Hee LeeYu Jeong ChoiSeung-Jun LeeSung-Jin HongChul-Min AhnByeong-Keuk KimYoung-Guk KoDonghoon ChoiMyeong-Ki HongYangsoo JangJung-Sun Kim
Keimyung Author(s)
Hur, Seung Ho
Department
Dept. of Internal Medicine (내과학)
Journal Title
J Am Coll Cardiol
Issued Date
2023
Volume
81
Issue
14
Keyword
atherosclerotic cardiovascular diseaseelderlyezetimibestatin
Abstract
Background:
The routine use of high-intensity statins should be considered carefully in elderly patients because of their higher risk of intolerance or adverse events.

Objectives:
We evaluated the impact of moderate-intensity statin with ezetimibe combination therapy compared with high-intensity statin monotherapy in elderly patients with atherosclerotic cardiovascular disease (ASCVD).

Methods:
In this post hoc analysis of the RACING (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases) trial, patients were stratified by age (≥75 years and <75 years). The primary endpoint was a 3-year composite of cardiovascular death, major cardiovascular events, or nonfatal stroke.

Results:
Among the 3,780 enrolled patients, 574 (15.2%) were aged ≥75 years. The rates of the primary endpoint were not different between the moderate-intensity statin with ezetimibe combination therapy group and the high-intensity statin monotherapy group among patients aged ≥75 years (10.6% vs 12.3%; HR: 0.87; 95% CI: 0.54-1.42; P = 0.581) and those <75 years (8.8% vs 9.4%; HR: 0.94; 95% CI: 0.74-1.18; P = 0.570) (P for interaction = 0.797). Moderate-intensity statin with ezetimibe combination therapy was associated with lower rates of intolerance-related drug discontinuation or dose reduction among patients aged ≥75 years (2.3% vs 7.2%; P = 0.010) and those <75 years (5.2% vs 8.4%; P < 0.001) (P for interaction = 0.159).

Conclusions:
Moderate-intensity statin with ezetimibe combination therapy showed similar cardiovascular benefits to those of high-intensity statin monotherapy with lower intolerance-related drug discontinuation or dose reduction in elderly patients with ASCVD having a higher risk of intolerance, nonadherence, and discontinuation with high-intensity statin therapy. (RAndomized Comparison of Efficacy and Safety of Lipid-lowerING With Statin Monotherapy Versus Statin/Ezetimibe Combination for High-risk Cardiovascular Diseases [RACING Trial]; NCT03044665).
Keimyung Author(s)(Kor)
허승호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1558-3597
Source
https://www.sciencedirect.com/science/article/pii/S0735109723003339
DOI
10.1016/j.jacc.2023.02.007
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/44984
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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