Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study

• Published in: International journal of cardiology Vol. 233; pp. 43 - 51
• Main Authors: Lin Wu, Fe-Lin, Wang, Jui, Ho, Wei, Chou, Chia-Hung, Wu, Yi-Jung, Choo, Dan-Wei, Wang, Yu-Wen, Chen, Po-Yu, Chien, Kuo-Liong, Lin, Zhen-Fang
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.04.2017
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - drug therapy; Acute Coronary Syndrome - epidemiology; Aged; Anticholesteremic Agents - administration & dosage; Cardiovascular; Comorbidity; Diabetes Mellitus - epidemiology; Dose-Response Relationship, Drug; Drug Therapy, Combination; Dyslipidemias - drug therapy; Dyslipidemias - epidemiology; Ezetimibe; Ezetimibe - administration & dosage; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Male; Middle Aged; Population Surveillance; Propensity Score; Statin; Survival Rate - trends; Taiwan - epidemiology; Time Factors; Treatment Outcome; Statin; Acute coronary syndrome; Comorbidity; Ezetimibe
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2017.02.006

Abstract Background The clinical benefits of a combination of statins and ezetimibe in patients with acute coronary syndrome (ACS) were observed in a clinical trial. However, little is known regarding the effectiveness of using statins with or without ezetimibe in patients with ACS and multiple comorbidities in real-world clinical practice. Methods This is a nationwide population-based cohort study using Taiwan National Health Insurance Research Database. A total of 212,110 patients with ACS who had been discharged after their first ACS events between 2006 and 2010 were enrolled. A propensity score matching approach was used to create matched cohorts for adjusting potential confounders. Cox proportional hazards regressions were performed to estimate the risk of re-hospitalization for ACS and revascularization. Results Patients in the statins-plus-ezetimibe group had a significantly lower risk of re-hospitalization for ACS (adjusted hazard ratio [HR] = 0.64, 95% confidence interval [CI]: 0.60–0.69) and revascularization (HR = 0.69, 95% CI: 0.63–0.76) than those in the statins-alone group. In the statins-plus-ezetimibe group, female patients had a lower risk of re-hospitalization for ACS than male patients did, and patients without diabetes mellitus had a lower risk of re-hospitalization for ACS than did patients with diabetes mellitus. Conclusions Patients with ACS and multiple comorbidities receiving a combination therapy of statins and ezetimibe had a lower risk of re-hospitalization for ACS and revascularization than those receiving statins alone. Significant interaction effects were observed between combination with ezetimibe, sex, and diabetes mellitus.