New hope for lipid-lowering beyond statins in high cardiovascular risk population - An in-depth look through the IMPROVE-IT trial
Journal
Journal of Internal Medicine of Taiwan
Journal Volume
27
Journal Issue
1
Pages
1-12
Date Issued
2016
Author(s)
Abstract
In the recently completed IMPROVE-IT trial, adding ezetimibe to simvastatin in a high-risk population with a recent acute coronary syndrome significantly reduced the risk of cardiovascular (CV) events relative to simvastatin alone. It is the first clinical trial to show a benefit of adding a non-statin lipid-modifying agent to statin therapy. Specifically, IMPROVE-IT trial demonstrates that ezetimibe added to a statin provides an incremental reduction in CV risk proportional to its ability to lower low density lipoprotein- cholesterol (LDL-C), as that predicted by the Cholesterol Treatment Trialists metaanalysis of statin trials. However, IMPROVE-IT trial should not be interpreted as showing anything uniquely beneficial about the use of ezetimibe. Indeed, the real implication of this trial is to suggest that all reductions in LDL-C levels, regardless of mechanism, are of equivalent benefit. These data also substantially reinforces the cholesterol theory, and proves that LDL-C is the most important surrogate marker for predicting CV outcomes. In addition, they demonstrate that even greater CV risk reductions can be safely achieved with additional reductions in LDL-C below the currently recommended goal. Taken together, the results are relevant to a better understanding of the relationship between LDL-C and CV risk and to clinical practice. IMPROVE-IT trial represents a milestone to establish the next step of lipid lowering strategy, but likely not the last advance in the on-going effort to achieve optimal CV risk reductions through lipid lowering therapy.
SDGs
Type
journal article