Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study

Fe-Lin Lin Wu; Jui Wang; Wei Ho; Chia-Hung Chou; Yi-Jung Wu; Dan-Wei Choo; Yu-Wen Wang; Po-Yu Chen; Kuo-Liong Chien; Zhen-Fang Lin

doi:10.1016/j.ijcard.2017.02.006

Effectiveness of a combination of ezetimibe and statins in patients with acute coronary syndrome and multiple comorbidities: A 6-year population-based cohort study

Int J Cardiol. 2017 Apr 15:233:43-51. doi: 10.1016/j.ijcard.2017.02.006. Epub 2017 Feb 3.

Authors

Fe-Lin Lin Wu¹, Jui Wang², Wei Ho³, Chia-Hung Chou⁴, Yi-Jung Wu⁵, Dan-Wei Choo³, Yu-Wen Wang³, Po-Yu Chen⁶, Kuo-Liong Chien⁷, Zhen-Fang Lin⁸

Affiliations

¹ School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Department of Pharmacy, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan.
² Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Road, Taipei, Taiwan.
³ School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
⁴ General Internal Medicine, The University of Chicago, Edward H. Levi Hall, 5801 South Ellis Avenue, Chicago, IL 60637, USA; Center for Translational and Policy Research of Chronic Diseases, The University of Chicago, Edward H. Levi Hall 5801 South Ellis Avenue, Chicago, IL 60637, USA.
⁵ School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Pharmaceutical Science, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
⁶ School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan.
⁷ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, No.17, Xu-Zhou Road, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan.
⁸ School of Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan; Department of Pharmacy, National Taiwan University Hospital, No.1, Changde St., Zhongzheng Dist., Taipei 10048, Taiwan; Graduate Institute of Pharmaceutical Science, College of Medicine, National Taiwan University, No.33, Linsen S. Rd., Zhongzheng Dist., Taipei 10050, Taiwan. Electronic address: zflin@ntu.edu.tw.

PMID: 28190615
DOI: 10.1016/j.ijcard.2017.02.006

Abstract

Background: The clinical benefits of a combination of statins and ezetimibe in patients with acute coronary syndrome (ACS) were observed in a clinical trial. However, little is known regarding the effectiveness of using statins with or without ezetimibe in patients with ACS and multiple comorbidities in real-world clinical practice.

Methods: This is a nationwide population-based cohort study using Taiwan National Health Insurance Research Database. A total of 212,110 patients with ACS who had been discharged after their first ACS events between 2006 and 2010 were enrolled. A propensity score matching approach was used to create matched cohorts for adjusting potential confounders. Cox proportional hazards regressions were performed to estimate the risk of re-hospitalization for ACS and revascularization.

Results: Patients in the statins-plus-ezetimibe group had a significantly lower risk of re-hospitalization for ACS (adjusted hazard ratio [HR]=0.64, 95% confidence interval [CI]: 0.60-0.69) and revascularization (HR=0.69, 95% CI: 0.63-0.76) than those in the statins-alone group. In the statins-plus-ezetimibe group, female patients had a lower risk of re-hospitalization for ACS than male patients did, and patients without diabetes mellitus had a lower risk of re-hospitalization for ACS than did patients with diabetes mellitus.

Conclusions: Patients with ACS and multiple comorbidities receiving a combination therapy of statins and ezetimibe had a lower risk of re-hospitalization for ACS and revascularization than those receiving statins alone. Significant interaction effects were observed between combination with ezetimibe, sex, and diabetes mellitus.

Keywords: Acute coronary syndrome; Comorbidity; Ezetimibe; Statin.

Publication types

Clinical Trial
Multicenter Study

MeSH terms

Acute Coronary Syndrome / drug therapy*
Acute Coronary Syndrome / epidemiology
Aged
Anticholesteremic Agents / administration & dosage
Comorbidity
Diabetes Mellitus / epidemiology*
Dose-Response Relationship, Drug
Drug Therapy, Combination
Dyslipidemias / drug therapy
Dyslipidemias / epidemiology*
Ezetimibe / administration & dosage*
Female
Follow-Up Studies
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage*
Male
Middle Aged
Population Surveillance*
Propensity Score
Survival Rate / trends
Taiwan / epidemiology
Time Factors
Treatment Outcome

Substances

Anticholesteremic Agents
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Ezetimibe