Long-term efficacy and safety of moderate-intensity statin with ezetimibe combination therapy versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (RACING): a randomised, open-label, non-inferiority trial

2022: The Year in Cardiovascular Disease – The Year of Upfront Lipid Lowering Combination Therapy.

“…LDL-C concentrations of <70 mg/dL at 1, 2, and 3 years were observed in 73%, 75%, and 72% of patients in the combination therapy group, and 55%, 60%, and 58% of patients in the high-intensity statin monotherapy group (all p<0.0001). The combination therapy was also significantly better tolerateddiscontinuation or dose reduction of the study drug by intolerance was observed in 88 patients (4.8%) and 150 patients (8.2%), respectively (p<0.0001) 44 . Finally, based on data from 38,023 consecutive patients with ACS from the Polish Registry of Acute Coronary…”

“…Despite a small proportion of patients reaching the recommended LDL-C level of < 70 mg/dl, a greater proportion of patients treated with FDC reached the goal (31.5%) compared to those with separate pills (21.0%) [ 43 ]. In a randomised, open-label, non-inferiority trial, 3780 ASCVD patients were randomly assigned to receive either moderate-intensity statin with ezetimibe combination therapy (rosuvastatin 10 mg with ezetimibe 10 mg; n = 1894) or high-intensity statin monotherapy (rosuvastatin 20 mg; n = 1886) [ 44 ]. The primary endpoint was the 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke.…”

World Heart Federation Cholesterol Roadmap 2022

“…This is supported by genetic studies, prospective cohort studies, randomised trials of cardiovascular outcomes and imaging studies assessing atherosclerosis progression/regression. Recent evidence demonstrates that it is the magnitude of LDL-C lowering rather than how it is achieved that drives benefit [11]. Thus LDL-C lowering (and by proxy non-HDL-C and apo B) should be considered in all individuals at higher risk [12] identified as such by the presence of i) a prevalent/prior manifestation of ASCVD; ii) the presence of a high risk condition such as diabetes, chronic kidney disease, or extreme elevations of BP which increase ASCVD risk even in the absence of accompanying lipid abnormalities; iii) extreme elevations of LDL-C which have a genetic basis like heterozygous familial hypercholesterolaemia (FH); iv) or those with high-CV risk due to combined effects of multiple risk factors; v) isolated elevations in atherogenic lipoproteins including triglyceride rich lipoproteins (commonly referred to as atherogenic dyslipidaemia) or elevations in lipoprotein(a); vi) those with elevated burden of subclinical atherosclerosis [13].…”

Global Trends in the Epidemiology and Management of Dyslipidemia

“…In addition to the cornerstone role of statins in reducing ASCVD risk, the role of lipid lowering treatment beyond statins cannot be ignored. There is considerable evidence supporting the benefits of nonstatin cholesterol-lowering medications in combination with statins, especially cholesterol absorption inhibitors (ezetimibe) and PCSK9 inhibitors [ 45 , 46 ]. Nonstatin use in the USA adult population has also increased by 124%, from 2.5% in 2002–2003 to 5.6% in 2012–2013, and 15.9% of high-intensity statin users also used nonstatin in 2012–2013 [ 47 ].…”