Statin-Ezetimibe Combination Therapy versus Statin Monotherapy in Atherosclerotic Cardiovascular Disease: A Prespecified Secondary Analysis of the Randomized Ez-PAVE Trial.

In 3-year follow-up of 3048 South Korean patients with atherosclerotic cardiovascular disease, initial statin-ezetimibe combination therapy did not significantly change the composite cardiovascular endpoint versus statin monotherapy (8.5% vs 7.9%; HR 1.07).

• Why it matters: It is unclear whether starting treatment with a statin-ezetimibe combination versus a statin alone improves outcomes when patients are managed using intensive or conventional LDL-C targets.
• What they did: In a prespecified secondary randomization of the Ez-PAVE trial, patients first assigned to intensive (<55 mg/dL) or conventional (<70 mg/dL) LDL-C targeting were then randomized to initial statin-ezetimibe (n=1525) or statin monotherapy (n=1523) and followed for 3 years.
• The result: The primary composite endpoint incidence was similar and safety endpoints did not differ, while median LDL-C was lower with combination therapy in both intensive (53 vs 62 mg/dL) and conventional targeting (63 vs 70 mg/dL).

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