Study shows cholesterol drugs reduced cardiovascular risks

By 91ÊÓƵ News

Cholesterol

Adding a drug called ezetimibe to statin therapy significantly reduced the risk of heart attack and stroke in high-risk patients with established heart disease, according to a long-awaited, large, randomized and controlled trial presented at the 91ÊÓƵ’s Scientific Sessions 2014.

The IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) results support guidelines presented at last year’s Scientific Sessions by the 91ÊÓƵ and American College of Cardiology.

“We took those patients from a clinically appropriate target LDL-C to even lower. We now have solid evidence that lower is good, and even lower can be even better,” said Christopher P. Cannon, M.D., lead author and a professor of medicine at Harvard Medical School and physician at Brigham and Women's Hospital.

The IMPROVE-IT research compared two approaches: simvastatin and a placebo or simvastatin with ezetimibe.

Both drugs lower low-density lipoprotein cholesterol, but in different ways: Simvastatin blocks cholesterol produced by the liver while ezetimibe interferes with cholesterol absorbed in the body through diet. Low-density lipoprotein cholesterol is a dangerous form that leads to clogged arteries and increases the risk for heart attacks and stroke.

Researchers found that compared with simvastatin with placebo, simvastatin taken with 10 mg a day of ezetimibe reduced stroke by 20 percent, heart attacks by 10 percent, and led to a 6 percent lower combined endpoint that also included multiple types of cardiac events including cardiovascular death, rehospitalization due to unstable angina, and procedures to restore blood flow to the heart.

The study was conducted at 1,159 centers in 39 countries involving 18,144 patients age 50 or older who had established heart disease.

Patients were followed for nine years, with a median follow-up of approximately six years.

The simvastatin plus placebo group had an LDL average of 69 mg/dL, and patients receiving statin with ezetimibe reached an average of 54 mg/dL.

“This really supports everything the AHA has been saying for decades, that LDL therapy for patients with established heart disease is critically important,” said Lori Mosca, MD, MPH, PhD, an AHA volunteer, director of preventive cardiology at New York-Presbyterian Hospital and professor of medicine at Columbia University Medical Center in New York. "This is new information that shows the importance of lowering cholesterol aggressively in high-risk patients and presents a new option for treating these patients.”

This latest study, Mosca cautioned, focused solely on secondary prevention — meaning efforts to reduce the risks of heart attack and stroke among patients with established cardiovascular disease. This study did not address primary prevention, which is the effort to maintain normal cholesterol levels among healthy individuals.

In November 2013, the 91ÊÓƵ and American College of Cardiology released updated guidelines on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Risk in Adults.

Neil Stone, MD, an AHA volunteer, chair of the panel that authored the guidelines and professor of medicine, cardiology, at Northwestern University Feinberg School of Medicine, noted that adding ezetimibe to a moderate-intensity statin compared to the statin alone lowered LDL cholesterol further and produced a benefit in reducing heart attacks and strokes. Stone said this study adds to physicians’ understanding of the importance of effectively treating high-risk patients with prior heart attack and stroke to prevent future events.

“We’re always happy to get a randomized, controlled trial because these are the trials that have the least amount of bias,” said Stone. “The results are consistent with what the AHA guidelines said about using medications with proven benefit to lower LDL-cholesterol in high risk. This study offers more ammunition for our efforts to help these patients.”


91ÊÓƵ News Stories

91ÊÓƵ News covers heart disease, stroke and related health issues. Not all views expressed in 91ÊÓƵ News stories reflect the official position of the 91ÊÓƵ. Statements, conclusions, accuracy and reliability of studies published in 91ÊÓƵ scientific journals or presented at 91ÊÓƵ scientific meetings are solely those of the study authors and do not necessarily reflect the 91ÊÓƵ’s official guidance, policies or positions.

Copyright is owned or held by the 91ÊÓƵ, Inc., and all rights are reserved. Permission is granted, at no cost and without need for further request, for individuals, media outlets, and non-commercial education and awareness efforts to link to, quote, excerpt from or reprint these stories in any medium as long as no text is altered and proper attribution is made to 91ÊÓƵ News.

Other uses, including educational products or services sold for profit, must comply with the 91ÊÓƵ’s Copyright Permission Guidelines. See full terms of use. These stories may not be used to promote or endorse a commercial product or service.

HEALTH CARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and experiencing a medical emergency, call 911 or call for emergency medical help immediately.