Page 6 - Reflections_dyslipidaemia_newsletter4_2023

REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #4 2023

Dyslipidaemia

This post-hoc analysis of the trial focused on patients ≥75 years of age (n=574, with 273 on the ezetimibe combination therapy
treatment strategy and 301 on high-intensity monotherapy), as compared to those <75 years (n=3206, with 1621 on ezetimibe
combination therapy and 1585 on high-intensity monotherapy). The primary endpoint was a three-year composite of CV death,
MACE, or non-fatal stroke.

In terms of the baseline demographics, the patients aged ≥75 years were more likely to have a higher proportion of previous coronary
artery bypass surgery (10.1% vs. 5.9%), previous cerebrovascular accidents (8.7% vs. 5.1%), and predisposing comorbidities,
including hypertension (79.3% vs. 64.4%) and CKD (23.3% vs. 8.0%). The baseline characteristics of patients receiving ezetimibe
combination therapy vs. high-intensity statin monotherapy were well-balanced, irrespective of age.

The rates of primary endpoint were not different between the moderate-intensity statin with ezetimibe combination therapy group and
the high-intensity statin monotherapy group (10.6% vs. 12.3%; HR: 0.87; CI: 0.54–1.42; p=0.581). In addition, the rates did not differ
significantly compared to those <75 years of age (8.8% vs. 9.4%; HR: 0.94; 95% CI: 0.73–1.18; p=0.570) (p for interaction = 0.797).
No significant interactions between age and treatment strategy were observed with regard to secondary efficacy endpoints, including
all-cause death, CV death, MACE, and non-fatal stroke.

Moderate-intensity statin with ezetimibe combination therapy was associated with lower rates of intolerance-related drug
discontinuation or dose reduction among patients aged ≥75 years (2.3% vs. 7.2%; p=0.010) and those <75 years (5.2% vs. 8.4%; p<
0.001) (p for interaction = 0.159). In patients aged ≥75 years, the rate of new-onset diabetes was lower in the ezetimibe combination
therapy group than in the high-intensity statin monotherapy group (10.0% vs. 18.7%; p=0.025), but in those aged <75 years, the rate
of new-onset diabetes did not differ between the two therapy groups (12.8% vs. 12.9%; p=0.938).

Among patients aged ≥75 years, median LDL-C level during the study period was 58 mg/dL (IQR: 48–71 mg/dL) in the ezetimibe
combination therapy group and 62 mg/dL (IQR: 52–76 mg/dL) in the high-intensity statin monotherapy group (p=0.002). Median
LDL-C levels were consistently lower in patients in the ezetimibe combination therapy group than in those in the high-intensity statin
monotherapy group at years one, two, and three (p=0.004, p=0.013, and p=0.036, respectively). Similar results were seen in those
<75 years of age, with lower median LDL-C levels in the ezetimibe combination therapy group at years one, two, and three
(all p <0.001).

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