Cardiology Xagena

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Type 2 diabetes mellitus: Simvastatin and Ezetimibe combination therapy is associated with a lower rate of major adverse cardiac events than high potency statins alone

Recent trials have shown a reduction in the risk of major adverse cardiac events ( MACE ) with Simvastatin and Ezetimibe ( Vytorin ) therapy in patients with acute coronary syndrome.
The potential benefits of combination of Simvastatin and Ezetimibe for patients at a lower risk of MACE are unclear.

A study aimed to investigate the differences of MACE risk between patients with type 2 diabetes mellitus ( DM ) using Simvastatin and Ezetimibe or high potency statins.

This population-based dynamic cohort study used data from the Taiwan National Health Insurance Database. The study subjects were patients with type 2 diabetes mellitus, aged between 40 and 75 years.
The Simvastatin and Ezetimibe group took Simvastatin and Ezetimibe only, and the statin group took Atorvastatin ( Lipitor ) or Rosuvastatin ( Crestor ) but not Simvastatin or Ezetimibe.
The two groups were matched for age, gender, medication date, diabetes mellitus diagnosis date, hypertension, and cardiovascular complications.

The outcome variable was new-onset MACE.

A total of 20,485 patients ( 53% male; 4099 in the Simvastatin and Ezetimibe group and 16,396 in the statin group ) were included, with a mean age of 59.1 years.

In a total of 37,388 person-years, 1100 patients developed new-onset MACE.

The annual incidence rate of new-onset MACE was lower in the combination of Simvastatin and Ezetimibe group ( 2.61% ) than that in the statin group ( 3.02% ) ( p = 0.0476 ).

After Cox regression analysis, Simvastatin and Ezetimibe use was independently associated with a lower risk of MACE ( hazard ratio, HR=0.77; 95% confidence interval 0.66–0.90 ).

In conclusion, compared to high potency statins alone, Simvastatin and Ezetimibe therapy was associated with a lower incidence of MACE in patients with type 2 diabetes mellitus. ( Xagena )

Changa SH, Int J Cardiol 2015; 190: 20-25