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From the Journals

Combination Lipid Therapy Lowers CV Risk

Meta-analysis shows a 19% reduction in all-cause mortality with combination lipid-lowering therapy vs statin monotherapy in high-risk patients.

Conexiant

A comprehensive meta-analysis found that the combination lipid-lowering therapy with statins and ezetimibe could reduce all-cause mortality, major adverse cardiovascular events, and stroke compared with statin monotherapy, with no significant increase in adverse events.

Led by Maciej Banach, MD, PhD, of the Lipid and Blood Pressure Meta-analysis Collaboration Group and the International Lipid Expert Panel, the analysis included 14 studies (11 randomized controlled trials and 3 cohort studies), involving 108,373 patients at high or very high cardiovascular risk. They published the findings in Mayo Clinic Proceedings.

Combination therapy reduced:

  • All-cause mortality by 19%
  • Major adverse cardiovascular events by 18%
  • Stroke incidence by 17%.

The mean age was 67.31 years in the combination group and 67.89 years in the monotherapy group. The combination therapy yielded a significantly greater reduction in low-density lipoprotein cholesterol (LDL-C) from baseline.

Adverse event rates—including gastrointestinal and musculoskeletal events—were comparable between the groups. The discontinuation rate was also similar, with a statistically nonsignificant 13% numerical reduction in discontinuation risk with combination therapy.

A network meta-analysis revealed that high-intensity statin therapy combined with ezetimibe was associated with the most pronounced mortality reduction among all regimens analyzed.

In a subgroup analysis by follow-up duration, investigators showed that studies with follow-up of 2 years or longer demonstrated a statistically significant reduction in all-cause mortality compared with studies with shorter follow-up.

The study authors concluded: “Combination lipid-lowering therapy was associated with an overall greater reduction in LDL-C; the same risk of adverse effects; and significantly lower risk of all-cause mortality, major adverse cardiovascular events, and stroke compared with statin monotherapy. Forthcoming guidelines should consider the lipid-lowering combination therapy as early as possible, preferably up-front, for more effective LDL-C goal achievement and significant reduction of cardiovascular disease outcomes and mortality in high- and very high–risk patients.”

Conflict of interest disclosures can be found in the study.