TY - JOUR
T1 - On-treatment analysis of the Improved Reduction of Outcomes
T2 - Vytorin Efficacy International Trial (IMPROVE-IT)
AU - Blazing, Michael A
AU - Giugliano, Robert P
AU - de Lemos, James A.
AU - Cannon, Christopher P
AU - Tonkin, Andrew
AU - Ballantyne, Christie M
AU - Lewis, Basil S.
AU - Musliner, Thomas A
AU - Tershakovec, Andrew M.
AU - Lokhnygina, Yuliya
AU - White, Jennifer A.
AU - Reist, Craig J
AU - McCagg, Amy
AU - Braunwald, Eugene
PY - 2016/12/1
Y1 - 2016/12/1
N2 - Background We aimed to determine the efficacy and safety of adding ezetimibe (Ez) to simvastatin (S) in a post–acute coronary syndrome (ACS) population in a prespecified on-treatment analysis. Methods We evaluated 17,706 post-ACS patients from the IMPROVE-IT trial who had low-density lipoprotein cholesterol values between 50 and 125 mg/dL and who received Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d (P/S). The primary composite end point was cardiovascular death, myocardial infarction, unstable angina, coronary revascularization ≥30 days postrandomization, or stroke. The on-treatment analysis included patients who received study drug for the duration of the trial or experienced a primary end point or noncardiovascular death within 30 days of drug discontinuation. Results Mean low-density lipoprotein cholesterol values at 1 year were 71 mg/dL for P/S and 54 mg/dL for Ez/S (absolute difference −17 mg/dL = −24%; P <.001). The 7-year Kaplan-Meier estimate of the primary end point occurred in 32.4% in the P/S arm and 29.8% in the Ez/S arm (absolute difference 2.6%; HRadj 0.92 [95% CI 0.87-0.98]; P =.01). The absolute treatment effect favoring Ez/S was 30% greater than in the intention-to-treat analysis of IMPROVE-IT. Conclusions This analysis provides additional support for the efficacy and safety of adding Ez to S in this high-risk, post-ACS population.
AB - Background We aimed to determine the efficacy and safety of adding ezetimibe (Ez) to simvastatin (S) in a post–acute coronary syndrome (ACS) population in a prespecified on-treatment analysis. Methods We evaluated 17,706 post-ACS patients from the IMPROVE-IT trial who had low-density lipoprotein cholesterol values between 50 and 125 mg/dL and who received Ez 10 mg/d with S 40 mg/d (Ez/S) or placebo with simvastatin 40 mg/d (P/S). The primary composite end point was cardiovascular death, myocardial infarction, unstable angina, coronary revascularization ≥30 days postrandomization, or stroke. The on-treatment analysis included patients who received study drug for the duration of the trial or experienced a primary end point or noncardiovascular death within 30 days of drug discontinuation. Results Mean low-density lipoprotein cholesterol values at 1 year were 71 mg/dL for P/S and 54 mg/dL for Ez/S (absolute difference −17 mg/dL = −24%; P <.001). The 7-year Kaplan-Meier estimate of the primary end point occurred in 32.4% in the P/S arm and 29.8% in the Ez/S arm (absolute difference 2.6%; HRadj 0.92 [95% CI 0.87-0.98]; P =.01). The absolute treatment effect favoring Ez/S was 30% greater than in the intention-to-treat analysis of IMPROVE-IT. Conclusions This analysis provides additional support for the efficacy and safety of adding Ez to S in this high-risk, post-ACS population.
UR - https://www.scopus.com/pages/publications/84991727507
U2 - 10.1016/j.ahj.2016.09.004
DO - 10.1016/j.ahj.2016.09.004
M3 - Article
C2 - 27914504
AN - SCOPUS:84991727507
SN - 0002-8703
VL - 182
SP - 89
EP - 96
JO - American Heart Journal
JF - American Heart Journal
ER -