Kelly Francinny Alves, de Moraes Francisco Cezar Aquino, Lôbo Artur de Oliveira Macena, Siebel Victória Morbach, Leite Marianna, de Almeida Artur Menegaz, Consolim-Colombo Fernanda Marciano
São Caetano do Sul University, São Paulo 01327-000, Brazil (Dr Kelly).
Federal University of Pará, Belém 66073-005, Brazil (de Moraes).
J Clin Lipidol. 2024 Nov-Dec;18(6):e893-e904. doi: 10.1016/j.jacl.2024.07.013. Epub 2024 Aug 14.
Atherosclerotic cardiovascular disease (ASCVD), affects approximately 18.6 million individuals worldwide and poses a significant healthcare related challenge. Despite the established efficacy of both high-intensity statin monotherapy (HIS) and moderate-intensity statin plus ezetimibe (MIS+EZT) in ASCVD management, the optimal treatment strategy remains unclear.
A thorough literature study was conducted across PubMed, Embase, and the Cochrane databases, focusing on studies that compared the effects of MIS+EZT with HIS monotherapy in ASCVD patients.
In the 13 included studies, involving 8,592 patients, 4,525 (52.67%) of which received moderate-intensity statin plus ezetimibe treatment. The follow-up period ranged from 4 to 156 weeks, with participant ages varying from 55.2 to 71 years old. Analysis revealed that MIS+EZT was associated with a significantly greater percentage of patients who achieved the goal of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL. (odds ratio [OR] 1.76; 95% CI [1.26; 2.45]; p = 0.001; I² = 73%); LDL-C reduction (mean difference [MD] -5.05 mg/dL; 95% CI [-9.02;-1.07]; p < 0.013; I² = 56%); total cholesterol reduction (MD -7.91 mg/ dL; 95% CI [-14.90; -0.91]; p < 0.027; I² = 60%) and triglyceride reduction (MD -8.20 mg/ dL; 95% CI [-13.05; -3.35]; p < 0.001; I² = 2%). There was no statistical difference between groups in drug adverse reaction (risk ratio [RR] 1.19; 95% CI [0.79; 1.78]; p = 0.404; I² = 0%) and drug intolerance (RR 0.78; 95% CI [0.32; 1.92]; p = 0.584; I² = 35%).
This meta-analysis highlights the effectiveness of MIS+EZT in significantly improving lipid profile components for ASCVD patients, as can been seen through the greater percentage of patients achieving the LDL-C < 70 mg/dL target and lower LDL-C, total cholesterol and triglyceride levels. Importantly, there were no significant differences in the occurrence of overall adverse events and adverse drug reactions between the two groups.
动脉粥样硬化性心血管疾病（ASCVD）影响着全球约1860万人，对医疗保健构成了重大挑战。尽管高强度他汀类单药治疗（HIS）和中等强度他汀类药物联合依折麦布（MIS+EZT）在ASCVD管理中已证实有效，但最佳治疗策略仍不明确。
对PubMed、Embase和Cochrane数据库进行了全面的文献研究，重点关注比较MIS+EZT与HIS单药治疗对ASCVD患者影响的研究。
在纳入的13项研究中，涉及8592例患者，其中4525例（52.67%）接受中等强度他汀类药物联合依折麦布治疗。随访期为4至156周，参与者年龄在55.2至71岁之间。分析显示，MIS+EZT组中达到低密度脂蛋白胆固醇（LDL-C）<70mg/dL目标的患者比例显著更高。（优势比[OR]1.76；95%置信区间[CI][1.26；2.45]；p=0.001；I²=73%）；LDL-C降低（平均差值[MD]-5.05mg/dL；95%CI[-
