Letter by Koh Regarding Article, “Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)”
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To the Editor:
Bohula et al1 report that there was a nonsignificant reduction in the first event of stroke of any pathogenesis (hazard ratio, 0.86; P=0.052) with ezetimibe/simvastatin versus placebo/simvastatin, driven by a significant 21% reduction in ischemic stroke (hazard ratio, 0.79) and a nonsignificant increase in hemorrhagic stroke (hazard ratio, 1.38; P=0.11).
Ezetimibe inhibits the absorption of cholesterol and lowers low-density lipoprotein (LDL) cholesterol level 3 times more when added to statins. Therefore, it is expected that ezetimibe/simvastatin significantly reduced the event of ischemic stroke. However, ezetimibe/simvastatin tended to increase the event of hemorrhagic stroke. Is it by chance?
Originally, too …