Likely to Be Beneficial For All
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Article, see p 1571
IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), conducted in 18 144 participants who had recently experienced an acute coronary syndrome, demonstrated that the addition of ezetimibe 10 mg to simvastatin 40 mg, both taken daily, reduced low-density lipoprotein (LDL) cholesterol by an additional 16 mg/dL in comparison with placebo added to simvastatin 40 mg daily. This led to a 6% proportional reduction in the risk of the primary cardiovascular outcome (a composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization, or nonfatal stroke) over 6 years (hazard ratio, 0.94; 95% confidence interval, 0.89–0.99; P=0.016).1 It is well established from statin trials that the relative cardiovascular benefit of LDL cholesterol lowering is proportional to the absolute LDL cholesterol reduction,2 and the additional vascular benefit afforded by adding ezetimibe to a statin-based regime in IMPROVE-IT was entirely consistent with this observation.1,2
In this issue of Circulation, the IMPROVE-IT investigators present exploratory analyses that raise hypotheses about groups of patients that may derive differential benefit from ezetimibe treatment. There is a particular focus on diabetes mellitus, which was present …