What is the clinical evidence from this study?

Study design: Observational. Population: Stroke with LDL-C ≥ 70 mg/dL despite statin monotherapy (n=1431). Intervention: Rosuvastatin plus ezetimibe combination therapy vs. Prior statin monotherapy (baseline). Primary outcome: Achieving LDL-C < 70 mg/dL at six months (95% CI 68.3-74.0).

November 12, 2025Open Access

Switching to rosuvastatin plus ezetimibe in statin-treated stroke patients with low-density lipoprotein cholesterol levels above 70 mg/dL (SWITCH): a prospective observational study

Q: What are the key findings of this study?

Switching to rosuvastatin plus ezetimibe combination therapy enabled 71.2% of stroke patients with suboptimal LDL-C on statin monotherapy to achieve LDL-C < 70 mg/dL at six months.

Key Result

Switching to rosuvastatin plus ezetimibe combination therapy enabled 71.2% of stroke patients with suboptimal LDL-C on statin monotherapy to achieve LDL-C < 70 mg/dL at six months.

Study Design

Type

Observational (n=1,431)

Blinding

Open-label

Multicenter

Yes

Structured PICO

Does switching to rosuvastatin plus ezetimibe improve LDL-C target achievement in stroke patients with LDL-C ≥ 70 mg/dL on statin monotherapy?

Population

1,431 adults (mean age 65.3, 66.8% male) with a history of stroke (99.5% ischemic) and baseline LDL-C ≥ 70 mg/dL despite statin monotherapy, from 16 Korean stroke centers.

Intervention

Switching to rosuvastatin plus ezetimibe combination therapy (5/10 mg, 10/10 mg, or 20/10 mg at investigator discretion) for 6 months.

Outcome

Proportion of participants achieving LDL-C < 70 mg/dL at six months after switching to rosuvastatin plus ezetimibe.surrogate

Switching from statin monotherapy to rosuvastatin plus ezetimibe effectively reduces LDL-C to target levels (<70 mg/dL) in over 70% of stroke patients in real-world practice.

Limitations

Open-label, observational, single-group study design cannot fully ascertain the direct contribution of the therapy switch to LDL-C reduction due to potential residual confounders.
Relatively high drop-out rate may introduce bias from participant attrition.
The primary outcome was LDL-C target achievement rate, which does not reflect clinical endpoints such as cardiovascular events.
Modest attainment of stricter LDL-C targets limits information for high-risk patients who may require additional lipid-lowering therapy.
Conducted exclusively in Korean patients, limiting the generalizability of the findings to other ethnicities.

Abstract

Effective lipid management is critical for secondary stroke prevention, however, many patients fail to achieve target low-density lipoprotein cholesterol (LDL-C) levels with statin monotherapy. This study evaluated the real-world effectiveness and safety of switching from statin monotherapy to rosuvastatin plus ezetimibe combination therapy (REZ) in patients with stroke. This multicenter, prospective, observational study enrolled patients with stroke and baseline LDL-C ≥ 70 mg/dL despite statin monotherapy from 16 Korean stroke centers. Participants were switched to REZ at doses of 5/10 mg, 10/10 mg, or 20/10 mg at the investigators’ discretion. Lipid profiles were assessed at three and six months. The primary outcome was achieving LDL-C < 70 mg/dL at six months. In total, 1,431 participants enrolled between May 2021 and March 2023 were eligible (mean age 65.3 ± 10.6 years; 66.8% male). Among 994 participants completing follow-up, the mean baseline LDL-C was 98.9 ± 22.4 mg/dL. At six months, 708 (71.2%) achieved LDL-C < 70 mg/dL. Mean LDL-C decreased to 62.7 ± 22.1 mg/dL at three months and to 62.0 ± 22.0 mg/dL at six months. The effectiveness of REZ remained consistent across different REZ dosages and regardless of changes in statin intensity during the switch. REZ was particularly effective in patients with diabetes (odds ratio 95% confidence interval, 1.85 1.32–2.59; P < 0.001) and baseline LDL-C 70–99 mg/dL (2.71 2.04–3.59; P < 0.001). Fewer participants achieved stricter targets (LDL-C < 55 mg/dL or LDL-C < 70 mg/dL plus 50% reduction). Switching to REZ effectively reduced LDL-C in patients with stroke receiving statin monotherapy with LDL-C ≥ 70 mg/dL, offering potential benefits for secondary cardiovascular prevention in real-world practice.

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Cite This Study

Yang et al. (Wed,) conducted a observational in Stroke with LDL-C ≥ 70 mg/dL despite statin monotherapy (n=1,431). Rosuvastatin plus ezetimibe combination therapy vs. Prior statin monotherapy (baseline) was evaluated on Achieving LDL-C < 70 mg/dL at six months (95% CI 68.3-74.0). Switching to rosuvastatin plus ezetimibe combination therapy enabled 71.2% of stroke patients with suboptimal LDL-C on statin monotherapy to achieve LDL-C < 70 mg/dL at six months.

synapsesocial.com/papers/6a0f574e42feb5cfcf9bd825 https://doi.org/https://doi.org/10.1186/s12944-025-02781-6

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