Lee Jayden, Egolum Ugochukwu, Parihar Harish, Cooley Michael, Ling Hua
School of Pharmacy, Philadelphia College of Osteopathic Medicine, Suwanee, GA, USA.
The Heart Center of Northeast Georgia Medical Center, Gainesville, GA, USA.
Cardiol Res. 2021 Apr;12(2):98-108. doi: 10.14740/cr1224. Epub 2021 Feb 23.
Adding ezetimibe to high-intensity statin therapy is used for additional lowering of low-density lipoprotein cholesterol (LDL-C); however, there are little data on the efficacy of ezetimibe when combined with a high-intensity statin. A meta-analysis was performed to evaluate the efficacy of ezetimibe added to high-intensity statin therapy on LDL-C levels.
A literature search from database inception to May 2020 was performed using PubMed, EMBASE and Cochrane Central Register of Controlled Trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this meta-analysis, in which the random-effects model was adopted for the calculation of the mean difference (MD). The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the quality of the included trials.
A total of 14 trials with 2,007 patients were included in this study. Compared to the high-intensity statin monotherapy, the MD in LDL-C reduction with high-intensity statin therapy plus ezetimibe was -14.00% (95% confidence interval: -17.78 to -10.22; P < 0.001) with a moderate degree of heterogeneity (P < 0.001, I = 66%). No significant publication bias among the included trials was identified.
Our study found that adding ezetimibe to high-intensity statin therapy provided a significant but attenuated incremental reduction in LDL-C levels. Whether the magnitude of this additional lowering of LDL-C levels would lead to benefits in clinical cardiovascular outcomes needs further investigation.
在高强度他汀类药物治疗基础上加用依折麦布用于进一步降低低密度脂蛋白胆固醇（LDL-C）；然而，关于依折麦布与高强度他汀类药物联合使用时的疗效数据较少。进行了一项荟萃分析以评估在高强度他汀类药物治疗基础上加用依折麦布对LDL-C水平的疗效。
使用PubMed、EMBASE和Cochrane对照试验中央注册库从数据库建立至2020年5月进行文献检索。本荟萃分析采用系统评价和荟萃分析的首选报告项目指南，其中采用随机效应模型计算平均差（MD）。使用Cochrane协作网的偏倚风险评估工具评估纳入试验的质量。
本研究共纳入14项试验，2007例患者。与高强度他汀类药物单药治疗相比，高强度他汀类药物治疗加用依折麦布降低LDL-C的MD为-14.00%（95%置信区间：-17.78至-10.22；P<0.001），异质性程度中等（P<0.001，I²=66%）。纳入试验中未发现显著的发表偏倚。
我们的研究发现，在高强度他汀类药物治疗基础上加用依折麦布可使LDL-C水平显著但程度减弱地进一步降低。这种LDL-C水平的额外降低幅度是否会给临床心血管结局带来益处，需要进一步研究。
