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Relative Effect of Current Intensive Lipid-Lowering Drugs on Cardiovascular Outcomes in Secondary Prevention - A
Shifei Wang1, Jiancheng Xiu1, Wangjun Liao2
1Department of Cardiology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University.
Insights
High-dose statin therapy demonstrated superior cardiovascular benefits over PCSK9 inhibitor-statin treatments in secondary prevention patients. This finding highlights the significant impact of high-dose statins on reducing major cardiovascular events and revascularization risks.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Research
Background:
- Cardiovascular disease remains a leading cause of mortality worldwide.
- Effective lipid-lowering therapies are crucial for secondary prevention.
- Comparative benefits of different intensive lipid-lowering strategies require elucidation.
Purpose of the Study:
- To compare the cardiovascular benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments.
- To evaluate these treatments in patients undergoing secondary prevention for cardiovascular disease.
- To assess the impact on major adverse cardiovascular events (MACE) and revascularization.
Main Methods:
- A meta-analysis of 12 randomized controlled trials involving 131,978 patients.
- Data sourced from PubMed and Embase up to June 1, 2018.
- Meta-regression and Cochran Q tests were used to explore subgroup differences.
Main Results:
- High-dose statin therapy showed a greater reduction in MACE and revascularization risk per 1 mmol/L LDL-C reduction compared to PCSK9 inhibitor-statin.
- Risk ratios for MACE: high-dose statin (0.86), ezetimibe-statin (0.90), PCSK9 inhibitor-statin (0.94).
- Risk ratios for revascularization: high-dose statin (0.84), ezetimibe-statin (0.91), PCSK9 inhibitor-statin (0.94).
Conclusions:
- High-dose statin therapy is significantly superior to PCSK9 inhibitor-statin for improving MACE and revascularization outcomes in secondary prevention.
- The relative benefits of intensive lipid-lowering treatments decreased gradually from high-dose statin to ezetimibe-statin to PCSK9 inhibitor-statin.
- These findings provide valuable insights for optimizing lipid-lowering strategies in high-risk cardiovascular patients.
Background:
We aimed to investigate the comparative cardiovascular benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments in secondary prevention patients.
Methods And Results:
We selected 12 randomized controlled trials (n=131,978 patients) using PubMed and Embase (inception-June 1, 2018). Subgroup differences were explored by meta-regression and Cochran Q test. The relative effects of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin on major cardiovascular events (MACE), and revascularization were varied and decreased gradually, of which high-dose statin resulted in lower risk of MACE and revascularization than PCSK9 inhibitor-statin per 1 mmol/L reduction of low-density lipoprotein cholesterol (LDL-C): risk ratio (RR) for MACE, 0.86 (95% confidence interval (CI), 0.81-0.90) for high-dose statin, 0.90 (95% CI, 0.83-0.96) for ezetimibe-statin, and 0.94 (95% CI, 0.92-0.96) for PCSK9 inhibitor-statin; RR for revascularization, 0.84 (95% CI, 0.77-0.90) for high-dose statin, 0.91 (95% CI, 0.81-1.00) for ezetimibe-statin, and 0.94 (95% CI, 0.90-0.97) for PCSK9 inhibitor-statin. Similar relative effects of intensive lipid-lowering treatment were also observed in analyses of myocardial infarction and stroke, although no significant difference between groups was identified.
Conclusions:
In secondary prevention patients, the relative benefits of high-dose statin, ezetimibe-statin, and PCSK9 inhibitor-statin treatments were varied and decreased gradually, of which high-dose statin was significantly superior to PCSK9 inhibitor-statin for improving MACE and revascularization per 1 mmol/L reduction of LDL-C.
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