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Moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome and atherosclerotic cardiovascular disease: A post-hoc analysis of the RACING trial

Authors
 Yong-Joon Lee  ;  Sang-Hyup Lee  ;  Seng Chan You  ;  Yong-Ho Lee  ;  Seung-Jun Lee  ;  Sung-Jin Hong  ;  Chul-Min Ahn  ;  Byeong-Keuk Kim  ;  Young-Guk Ko  ;  Donghoon Choi  ;  Myeong-Ki Hong  ;  Yangsoo Jang  ;  Jung-Sun Kim 
Citation
 DIABETES OBESITY & METABOLISM, Vol.26(3) : 829-839, 2024-03 
Journal Title
DIABETES OBESITY & METABOLISM
ISSN
 1462-8902 
Issue Date
2024-03
MeSH
Anticholesteremic Agents* / adverse effects ; Atherosclerosis* / complications ; Atherosclerosis* / drug therapy ; Atherosclerosis* / prevention & control ; Cardiovascular Diseases* / complications ; Cardiovascular Diseases* / epidemiology ; Cholesterol, LDL ; Diabetes Mellitus* / drug therapy ; Drug Therapy, Combination ; Ezetimibe / therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects ; Metabolic Syndrome* / complications ; Metabolic Syndrome* / drug therapy ; Treatment Outcome
Keywords
atherosclerotic cardiovascular disease ; ezetimibe ; metabolic syndrome ; statin
Abstract
Aim: This study evaluated the safety and efficacy of a moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with metabolic syndrome (MetS) and atherosclerotic cardiovascular disease.

Materials and methods: In this post-hoc subgroup analysis of the RACING trial, patients were analysed based on the presence of MetS. MetS was defined as meeting at least three of the five following criteria: (a) elevated waist circumference; (b) elevated triglycerides; (c) reduced high-density lipoprotein cholesterol; (d) elevated blood pressure; and (e) elevated fasting glucose. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke.

Results: Of the 3780 patients enrolled in the RACING trial, 1703 (45.1%) had MetS at baseline. The primary outcome rate was 10.1% and 10.3% in patients with MetS receiving ezetimibe combination therapy versus high-intensity statin monotherapy (hazard ratio = 0.97; 95% confidence interval = 0.72-1.32; p = .868). Lower rates of intolerance-related drug discontinuation or dose reduction (3.9% vs. 8.0%; p < .001) and lower low-density lipoprotein cholesterol levels (57 vs. 65 mg/dl; p < .001) were observed with ezetimibe combination therapy versus high-intensity statin monotherapy. Furthermore, the rate of new-onset diabetes was 18.5% and 19.1% in each group (p = .822). There were no significant interactions between MetS and therapy regarding study outcomes in the total population.

Conclusions: In patients with MetS and atherosclerotic cardiovascular disease, a moderate-intensity statin with ezetimibe combination therapy had comparable cardiovascular benefits with those of high-intensity statin monotherapy. Meanwhile, ezetimibe combination therapy was associated with lower drug intolerance and low-density lipoprotein cholesterol levels, but there was no apparent between-group difference in new-onset diabetes.
Full Text
https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.15374
DOI
10.1111/dom.15374
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Biomedical Systems Informatics (의생명시스템정보학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Ko, Young Guk(고영국) ORCID logo https://orcid.org/0000-0001-7748-5788
Kim, Byeong Keuk(김병극) ORCID logo https://orcid.org/0000-0003-2493-066X
Kim, Jung Sun(김중선) ORCID logo https://orcid.org/0000-0003-2263-3274
Ahn, Chul-Min(안철민) ORCID logo https://orcid.org/0000-0002-7071-4370
You, Seng Chan(유승찬) ORCID logo https://orcid.org/0000-0002-5052-6399
Lee, Sanghyup(이상협)
Lee, Seung-Jun(이승준) ORCID logo https://orcid.org/0000-0002-9201-4818
Lee, Yong Joon(이용준)
Lee, Yong Ho(이용호) ORCID logo https://orcid.org/0000-0002-6219-4942
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Hong, Myeong Ki(홍명기) ORCID logo https://orcid.org/0000-0002-2090-2031
Hong, Sung Jin(홍성진) ORCID logo https://orcid.org/0000-0003-4893-039X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198668
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