WASHINGTON, DC—For some atherosclerotic cardiovascular disease (ASCVD) patients on statin therapy, the addition of ezetimibe may not provide enough benefit to help these high risk patients reach low-density lipoprotein cholesterol (LDL-C) goals. Findings from this real-world study were presented at the ACC.17 Scientific Session.

To investigate the effectiveness of ezetimibe, a cholesterol absorption inhibitor, researchers from TechData Service Company, King of Prussia, PA, and Sanofi, Bridgewater, NJ, identified a cohort of adult ASCVD patients between January 2007 and June 2015 using the Optum Clinformatics claims database. These patients were all current statin users, had an LDL-C ≥70mg/dL and were starting treatment with ezetimibe. Patients were considered to have reached goal if they achieved an LDL-C level of less than 70mg/dL after 3 months of ezetimibe treatment.

One thousand four hundred and fifty-one patients were included in the study (mean age: 65 years; 56% male; 48% on high-intensity statins). After 3 months of treatment with ezetimibe, 48% of patients with baseline LDL-C between 70mg/dL and 99mg/dL achieved goal; this group saw a 12% reduction in LDL-C. For patients with a baseline LDL-C between 100 and 129mg/dL, 31% of patients achieved goal with a reduction in LDL-C of 21%. Only 10% of patients with baseline LDL-C ≥130mg/dL achieved goal, however they had the largest reduction in LDL-C (-27%). 

Higher baseline LDL-C, no baseline high-intensity statin use, and poor ezetimibe adherence all contributed to smaller LDL-reductions and reduced odds of goal achievement. This pattern of results were also seen for ezetimibe patients in the ODYSSEY trial, observed study authors.

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“While we observed largely comparable LDL-C reductions by ezetimibe in real-world ASCVD patients to those from randomized clinical trials, the majority of patients could not achieve a goal of <70mg/dL. For these high CV risk patients, better treatment options with more potent LDL-C reduction may be warranted,” Ye Tian, lead author of the study, concluded.