Alternative low-density lipoprotein–lowering strategies, including moderate-intensity statins with ezetimibe, demonstrated similar efficacy to high-intensity statins in preventing major adverse cardiovascular events and were associated with a reduced risk of new-onset diabetes and statin intolerance, according to a recent study.
In the systematic review and meta-analysis of 8,180 patients with atherosclerotic cardiovascular disease (ASCVD), investigators compared the efficacy and safety of alternative low-density lipoprotein (LDL) cholesterol–lowering strategies with high-intensity statin therapy. The analysis, published in JAMA Cardiology, included data from the RACING and LODESTAR trials, which evaluated moderate-intensity statins combined with ezetimibe or titrated statin therapy targeting specific LDL cholesterol levels.
The primary composite endpoint—comprising all-cause mortality, myocardial infarction, stroke, or coronary revascularization—did not significantly differ between the groups (7.5% vs 7.7%, hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.84–1.15, P = .82). LDL cholesterol levels were slightly lower in the alternative strategy group (64.8 mg/dL vs 68.5 mg/dL, P < .001), demonstrating comparable lipid-lowering efficacy.
Notably, new-onset diabetes occurred less frequently with the alternative therapies compared with high-intensity statins (10.2% vs 11.9%, P = .047), and fewer patients required initiation of antidiabetic medications (6.5% vs 8.2%, P = .02). Therapy discontinuation or dose reduction as a result of intolerance was also lower in the alternative group (4.0% vs 6.7%, P < .001).
While these findings suggested that alternative LDL-lowering strategies may be suitable for patients who are intolerant to high-intensity statins or at risk of diabetes, high-intensity statins remain the standard of care for ASCVD. Future research could explore the role of lipid-lowering agents, such as PCSK9 inhibitors, in combination with moderate-intensity statins.
Full disclosures can be found in the published study.
