Evidence map›Paper›PMID 39567875›Full record

SynthesisBMC cardiovascular disorders2024

The clinical effectiveness and safety of low/moderate-intensity statins & ezetimibe combination therapy vs. high-intensity statin monotherapy: a systematic review and meta-analysis.

Pishoy Sydhom, Bakr Al-Quraishi, Mohamad El-Shawaf, Mohamed T Osman, Nourhan Naji, Nouran Awwad, Nahla Shehata, Mostafa Osama, Heba Sergany, Kerollos F Maurice and 1 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC cardiovascular disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Review
  6. Observational
  7. Review
  8. Article
  9. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Pishoy SydhomFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt. pishoysydhom@gmail.com.
Bakr Al-QuraishiFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Mohamad El-ShawafFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Mohamed T OsmanFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Nourhan NajiFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Nouran AwwadFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Nahla ShehataFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Mostafa OsamaFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Heba SerganyFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Kerollos F MauriceFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.
Ahmed SayedFaculty of Medicine, Ain-Shams University, 56Th Abbaseyia Street, Cairo, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite widespread use of high-intensity statin monotherapy, achieving target LDL-C levels and reducing cardiovascular events in patients with or at high risk of developing ASCVD remains challenging. Our study measured the effects of low/moderate-intensity statins and ezetimibe combination therapy compared to high-dose statin monotherapy on major adverse cardiovascular events (MACEs) and coronary atherosclerotic plaque reduction.

methodsWe searched PubMed, Scopus, Web of Science, and Cochrane CENTRAL register of trials for studies comparing the combination therapy to high-intensity statin monotherapy in terms of MACEs and coronary atherosclerotic plaque reduction. The primary outcome was a composite of cardiovascular death or major cardiovascular events (MI, HF, Revascularization, or non-fatal stroke). Other outcomes included other MACEs, lipid-lowering efficacy, and safety outcomes. A protocol was registered to PROSPERO under registration number [CRD42024545807].

results15 studies encompassing 251,450 participants were included in our meta-analysis. In our pooled analysis of observational studies, combination therapy was associated with lower rates of the primary composite outcome (HR = 0.76, CI 95% [0.73, 0.80]), cardiovascular death (HR = 0.80, CI 95% [0.74, 0.88]), all-cause death (HR = 0.84, CI 95% [0.78, 0.91]), and non-fatal stroke (HR = 0.81, CI 95% [0.75, 0.87]). However, the pooled analysis of RCTs did not demonstrate a statistically significant difference between both arms concerning clinical endpoints. Combination therapy had a higher number of patients with LDL-C < 70 mg/dL (RR = 1.27, CI 95% [1.21, 1.34]), significantly lowered LDL-C (MD = -7.95, CI 95% [-10.02, -5.89]) and TC (MD = -26.77, CI 95% [-27.64, -25.89]) in the pooled analysis of RCTs. In terms of safety, the combination therapy lowered muscle-related adverse events (RR = 0.52, CI 95% [0.32, 0.85]) and number of patients with liver enzyme elevation (RR = 0.51, CI 95% [0.29, 0.89]) in the pooled analysis of RCTs and was associated with lower rates of new-onset diabetes (HR = 0.80, CI 95% [0.74, 0.87]) in the pooled analysis of observational studies.

conclusionEvidence from RCTs indicates that low/moderate statin therapy in combination with ezetimibe has a superior lipid-lowering effect and reduces side effects compared to high-dose statins. Observational studies suggest improved clinical outcomes but need to be corroborated by large, outcomes-powered RCTs over longer follow-up periods.

Indexed as

Hydroxymethylglutaryl-CoA Reductase InhibitorsAgedAnticholesteremic AgentsBiomarkersCardiovascular DiseasesCholesterol, LDLCoronary Artery DiseaseDrug Therapy, CombinationDyslipidemiasEzetimibeFemaleHumansMaleMiddle AgedPlaque, AtheroscleroticRisk AssessmentAnticholesteremic AgentsBiomarkersCholesterol, LDLEzetimibeHydroxymethylglutaryl-CoA Reductase InhibitorsCardiovascular eventsCoronary artery diseaseEzetimibeLDL-CStatins

Identifiers

PMID39567875
PMCPMC11577940

What Socratic holds

Texttitle and abstract
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.