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Upfront Combo Lipid-Lowering Therapy Best for Acute Coronary Syndrome

(HealthDay News) — For patients with acute coronary syndromes (ACS), an upfront combination lipid-lowering therapy is significantly better than statin monotherapy for all-cause mortality, according to a study published online in the Journal of the American Heart Association.

Joanna Lewek, MD, PhD, from the Medical University of Lodz in Poland, and colleagues compared statin monotherapy and upfront combination therapy of statin and ezetimibe in a cohort of 38,023 consecutive patients with ACS who were discharged alive from a national, multicenter prospective observational registry. Two groups were analyzed after propensity score matching: statin monotherapy (atorvastatin or rosuvastatin; 768 patients) and upfront combination therapy of statin and ezetimibe (768 patients).

The researchers found that during follow-up, there was a significant difference in mortality between the groups at one (5.9% vs 3.5%), 2 (7.8% vs 4.3%), and 3 (10.2% vs 5.5%) years of follow-up, favoring the upfront combination group; the difference was also significant for the overall period. Compared with atorvastatin, rosuvastatin significantly improved prognosis (odds ratio, 0.790). A significant reduction in all-cause mortality was seen with upfront combination therapy versus statin monotherapy (odds ratio, 0.526), with an absolute risk reduction of 4.7% after 3 years.

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“We proved, for the first time, that upfront combination lipid-lowering therapy is superior to statin monotherapy for all-cause mortality,” the authors write. “It undermines the stepwise approach, confirming the benefit of using the upfront combination strategy in patients with very high cardiovascular disease risk.”

Several authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text