Abstract 1427: Ezetimibe in Combination With a Statin Does Not Reduce All- Cause Mortality
Introduction - Although the ezetimibe-statin combination has been shown to reduce LDL cholesterol by 12% compared to a statin alone, its effect on hard clinical endpoints such as mortality is poorly understood. Prior trials evaluated the effect of ezetimibe-statin combination in highly select population groups, but its impact on all- cause mortality in the general clinic population has not been reported.
Methods - A total of 5743 subjects who were prescribed either a statin (group 1) or the combination of statin with ezetimibe (group 2) between January 2005 and December 2007 were included in the study. Socio-demographic, clinical variables and mortality records were retrieved electronically. Univariate and stepwise multivariate logistic regression analysis was performed to identify the impact of ezetimibe on all-cause mortality; controlling for patient characteristics, selected cardiovascular diseases and risk factors, and medications.
Results- Group 1 (n=4458), and group 2 (n= 1258) were similar in regards to most demographic variables. 279 patients died from any cause during the study period. There was no difference in all cause mortality between the two groups. Hypertension, lower HDL and omega 3 fatty acid use were shown to be associated with ezetimibe use in this cohort of patients and were considered as covariates in the analysis. Patients on the drug combination did not experience lower mortality after controlling for covariates and other significant risk factors (Table⇓).
Conclusions -No significant survival benefit was found with the use of ezetimibe in combination with a statin. Randomized trials investigating the effectiveness of ezetimibe in the general population are much needed. Physiologic sequelae of ezetimibe use such as lowered HDL may be associated with loss of any benefit of additive LDL reduction. Omega 3 fatty acid use demonstrated a substantial survival benefit.