Moderate-intensity statin with ezetimibe vs. high-intensity statin in patients with diabetes and atherosclerotic cardiovascular disease in the RACING trial. (19th December 2022)

• Record Type: Journal Article
• Authors: Lee, Yong-Joon; Cho, Jae Young; You, Seng Chan; Lee, Yong-Ho; Yun, Kyeong Ho; Cho, Yun-Hyeong; Shin, Won-Yong; Im, Sang Wook; Kang, Woong Chol; Park, Yongwhi; Lee, Sung Yoon; Lee, Seung-Jun; Hong, Sung-Jin; Ahn, Chul-Min; Kim, Byeong-Keuk; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo; Kim, Jung-Sun
• Is Part Of: European heart journal. Volume 44:Number 11(2023)
• Page Start: 972
• Page End: 983
• Publication Date: 2022-12-19
• Subjects: Ezetimibe -- Statin -- Diabetes mellitus -- Atherosclerotic cardiovascular disease; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac709
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: This study evaluated the effect of moderate-intensity statin with ezetimibe combination therapy vs. high-intensity statin monotherapy among patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). Methods and results: This was a pre-specified, stratified subgroup analysis of the DM cohort in the RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe combination therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95% confidence interval: 0.64–1.22; P = 0.460). Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in each group, respectively ( P = 0.014). LDL cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%, 83.1%, and 79.9% of patients in the ezetimibe combination therapy group, and 64.1%, 70.2%, and 66.8% of patients in the high-intensity statin monotherapy group (all P < 0.001). In the total population, no significant interactions were found between DM status and therapy regarding primary outcome, intolerance-related discontinuation or dose reduction, and the proportion of patients with LDL cholesterol levels <70 mg/dL. Conclusion: Ezetimibe combination therapy effects observed in the RACING trial population are preserved among patients with DM. This study supports moderate-intensity statin with ezetimibe combination therapy as a suitable alternative to high-intensity statins if the latter cannot be tolerated, or further reduction in LDL cholesterol is required among patients with DM and ASCVD. Clinical Trial Registration: ClinicalTrials.gov, Identifier:NCT03044665. Structured Graphical Abstract: Structured Graphical Abstract Audio Abstract: