- Question
- Does adding ezetimibe to statin therapy reduce cardiovascular events in patients recently hospitalized with an acute coronary syndrome, by lowering LDL cholesterol further?
- Design
- Double-blind, randomized trial of 18144 patients hospitalized for an acute coronary syndrome within the preceding 10 days, with a median follow-up of 6 years.
- Population
- Patients hospitalized for an acute coronary syndrome in the previous 10 days, with LDL cholesterol of 50 to 100 mg/dL if on lipid-lowering therapy or 50 to 125 mg/dL if not.
- Intervention
- Combination of simvastatin 40 mg and ezetimibe 10 mg.
- Control
- Simvastatin 40 mg plus placebo (simvastatin monotherapy).
- Primary outcome
- Composite of cardiovascular death, nonfatal myocardial infarction, unstable angina requiring rehospitalization, coronary revascularization (≥30 days after randomization), or nonfatal stroke.
- Results
- Median time-weighted average LDL cholesterol was 53.7 mg/dL with simvastatin-ezetimibe versus 69.5 mg/dL with simvastatin alone (P<0.001). The Kaplan-Meier primary end point rate at 7 years was 32.7% versus 34.7% (absolute risk difference 2.0 percentage points; HR 0.936; 95% CI 0.89 to 0.99; P=0.016).
- Safety
- Rates of prespecified muscle, gallbladder, and hepatic adverse effects and of cancer were similar in the two groups.
- Conclusion
- Adding ezetimibe to statin therapy produced incremental LDL lowering and improved cardiovascular outcomes, showing additional benefit from lowering LDL below previous targets.
- Why it matters
- It showed that a nonstatin lipid-lowering drug can improve clinical outcomes when added to a statin, supporting the concept that lowering LDL cholesterol further provides added benefit in high-risk patients.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026