Differential association of ezetimibe-simvastatin combination with major adverse cardiovascular events in patients with or without diabetes: a retrospective propensity score-matched cohort study

• Published in: Scientific reports Vol. 8; no. 1; pp. 11925 - 7
• Main Authors: Lee, Yong-ho, Hong, Namki, Lee, Chan Joo, Park, Sung Ha, Lee, Byung-Wan, Cha, Bong-Soo, Kang, Eun Seok
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 09.08.2018; Nature Publishing Group
• Subjects: 692/163/2743/137/138; 692/163/2743/2099; Aged; Anticholesteremic Agents - adverse effects; Anticholesteremic Agents - therapeutic use; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - prevention & control; Cardiovascular System - drug effects; Cardiovascular System - pathology; Clinical trials; Cohort analysis; Diabetes; Diabetes mellitus; Diabetes Mellitus - drug therapy; Ezetimibe, Simvastatin Drug Combination - adverse effects; Ezetimibe, Simvastatin Drug Combination - therapeutic use; Female; Health risk assessment; Hemorrhage; Humanities and Social Sciences; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Kaplan-Meier Estimate; Male; Middle Aged; multidisciplinary; Propensity Score; Retrospective Studies; Science; Science (multidisciplinary); Simvastatin; Simvastatin - adverse effects; Simvastatin - therapeutic use; Stroke; Treatment Outcome
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-018-30409-6

Clinical trials suggested that the benefits of ezetimibe-statin combination therapy on major adverse cardiovascular events (MACE) might be greater in patients with diabetes. We aimed to investigate the differential association of ezetimibe-statin combination with incident MACE by presence of diabetes. In this retrospective cohort study, subjects treated with simvastatin 20 mg plus ezetimibe 10 mg (S + E) or simvastatin 20 mg alone (S) between 2005 and 2015 were 1:1 matched using propensity score as stratified by diabetes. Primary outcome was newly-developed MACE composed of cardiovascular death, ACS, coronary revascularization, or non-hemorrhagic stroke. During 5,077 and 12,439 person-years, the incidence rates of MACE were 24.9, 20.1, 35.3, and 22.8/1000 person-years among no diabetes S, no diabetes S + E, diabetes S, and diabetes S + E, respectively. Relative to no diabetes S, adjusted HR (aHR) for MACE in diabetes S was 1.23 ( p  = 0.086), whereas S + E was associated with a lower risk of MACE in both non-diabetic patients (aHR 0.76, p  = 0.047) and diabetic patients (aHR 0.60, p  = 0.007) with significant difference (relative excess risk due to interaction = −0.39, p  = 0.044). In conclusion, reduction of MACE risk associated with ezetimibe plus simvastatin therapy relative to simvastatin alone was greater in patients with diabetes than in patients without diabetes.